The lips play a major role in the appearance of the lower third of the face. Their size and shape gives indications of gender, expression and age. The lips are well known to be affected by age with thinning of the amount of vermilion show, lip lines and downturning of the corners of the mouth. The inversion of the smile line is caused by the overall southern slide of the facial tissues from the cheeks down to the jawline. This pushes the sides of the mouth downward while the central portion of the lips remains stable.
The correction of downturned mouth corners to a more horizontal position is done by a corner of mouth lift procedure. This is a rather old anti-aging mouth procedure that employs a wedge of skin excision just above the downturned mouth corner. In a triangular or heart-shaped pattern, the removed skin allows a place for the depressed mouth corner to be elevated and inset. While effective it leaves an incision line on the skin that trails away from the mouth corner in the direction of the ear.
I have never liked this resultant skin scar from the traditional corner of mouth lift. As a result I have devised a new variation of this operation that eliminates this skin scar. The excision pattern is done using a ‘pennant’ skin excision/incision line pattern. The skin above the mouth corner is removed in a triangular pattern but there is an incision line that goes down along the lower lip vermilion-cutaneous junction. This allows the corner of the mouth to be excised and the mucosal mobilized. A wedge of orbicularis muscle is also removed and sutured upward to create a deeper corner of the mouth elevation. The corner of the mouth is then elevated and inset into the skin removal site.
This mouth corner mucosal transposition flap effectively raises the mouth corner but keeps all the incision lines at the vermilion-cutaneous junctions. It does lengthen the horizontal smile line a few millimeters per side but this is often an aesthetic benefit. If one so desires the mouth corner can be elevated even higher above the traditional horizontal level into a more upward turn. (lip curls)
Dr. Barry Eppley