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Archive for the ‘corner of mouth lift’ Category

Case Study- Pennant Corner of Mouth Lift for Correction of the Frowning Mouth

Monday, May 29th, 2017

 

Background: The smile is one of the most important forms of facial expression. The perception of the entire face changes as soon as one sees someone smile. But the time when one is smiling is far more limited than when one is expressionless. While an expressionless face is supposed to convey no emotion that is not always true.

With aging, and in some people naturally, the corners of the mouth can turn down in the static face. This creates the appearance of unhappiness or anger even when one does not have those emotions. This is very frustrating for those so affected as there is nothing they one can do about this appearance of their mouth. I have heard many patients tell me how this adversely affects their relationships both socially and at work.

Lifting up the downturned corner of the mouth would seem to be improved by a variety of facelifting procedures. Whether it is a lower facelift of a midface lift, neither of these procedures will provide any significant or sustained improvement in correcting the perpetual frown. Only by directly treating the downturned mouth corner can it be favorably changed.

Case Study: This 65 year-old male had a perpetual frown from his mouth corners being turned downward. This negatively impacted his perception of himself to others. He was tired of being told he was unhappy or mad.

Under local anesthesia a pennant-type corner of mouth lift was bilaterally performed.

In this procedure a pennant-shaped segment of skin is removed above each mouth corner down to the orbicularis muscle. The vermilion mouth corner is mobilized by a back cut along the lower lip vermilion and separated from the underlying muscle. A wedge of muscle is removed inferiorly and then left and sewn to the upper portion of the muscle. The mouth corner is then elevated up to the apex of the pennant skin excision and closed in two layers. He also had a subnasal lip performed at the same time for a more complete upper lip rejuvenation.

A three month follow-up showed mouth corners that were at a completely horizontal level. At rest his mouth no longer looked unhappy. Instead he almost looked like there was a slight smile instead…even at rest.

Highlights:

  1. The cornerstone of correction of the frowning mouth is a corner of mouth lift.
  2. The pennant corner of the the mouth lift technique limits the scar line to the vermilion-cutaneous junction.
  1. The corner of mouth lift changes the position of the mouth corner at end of the smile line as well as tucks up the orbicularis muscle.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Extreme Upper and Lower Lip Advancements with Mouth Corner Lifts

Sunday, April 30th, 2017

 

Background: Lip augmentation is one of the most popular non-surgical facial enhancement procedures. Done primarily by synthetic injectable fillers the size of the lips can be increased for the duration of the filler’s persistence. When skillfully done injectable fillers can create a myriad of perioral effects from lip size increase, correction of lip asymmetries and corner of the mouth lifts.

The effectiveness of fillers in the lip is based on having enough vermilion height so it can be expanded superiorly as well as outward. When the lips are very thin with a small amount of vermilion show, the push of the fillers is going to more outward than upward. This creates the dreaded ‘ducklip’ effect in which the lips are disproportionately balanced between their projection and height.

With poor responses to fillers in thin lips, changing the location of the vermilion border is the most effective approach. This his known as a lip advancement procedure and can be done on both the upper and lower lips. It is particularly effective in vermilion height asymmetries due to the ability to precisely change the location of the vermilion-skin border line.

Case Study: This 35 year-old female wanted bigger lip but also correction of her natural upper lip asymmetry. She previously had a congenital nevus removed from the left side of her upper lip which further contributed to her natural lip asymmetry. She had injectable fillers placed into her lips numerous times in the past but didn’t want to continue with that recurring expense.

Under local anesthesia with infraorbital and mental nerve blocks, lip advancements were performed. A 3mm lower lip advancement and an asymmetric 5/3.5mm upper lip advancement were performed combined with corner of the mouth lifts through a triangular skin excision. At the end of the procedure, the instantaneous size increase and improved lip symmetry could be seen. Between the use of local anesthetic and swelling, the lips looked enormous in size at the completion of the procedure but this will recede to a more normal appearance in 10 to 14 days later.

Highlights:

  1. Lip advancements are the most powerful surgical form of lip augmentation as they affect the whole lip from corner to corner.
  2. Lip advancements are the most effective form of lip asymmetry correction whether it is a partial or complete advancement.
  1. Upper and lower lip advancements done together create the most dramatic effects even at 3mm to 4mms of advancement per lip.

Dr. Barry Eppley

Indianapolis, Indiana

Technical Strategies – Pennant Corner of Mouth Lift

Sunday, February 26th, 2017

 

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.

Pennant Corner of the Mouth Lift Dr Barry Eppley IndianapolisI 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.

Corner of Mouth Lift result front viewCorner of Mouth Lift result Indianapolis Dr Barry EppleyThis 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

Indianapolis, Indiana

Case Study – Male Mouth Rejuvenation

Sunday, January 22nd, 2017

 

Background: Aging affects all areas of the face and is always most observed in the sphinteric areas of the eyes and mouth. The mouth develops very consistent age-related changes including thinning of lip vermilion show, lengthening of the upper lip and a downward slant to the corners of the mouth. It is all part of the overall tissue shrinkage and southern drift that occurs in overall facial aging.

One of the main differences in male vs. female perioral aging is that men develop far less vertical lip wrinkles. The thicker skin of men due to containing hair follicles and the lifelong use of microdermabrasion (shaving) accounts for the far less number and depth of perioral wrinkles.

The other difference between men and women in age-related mouth changes is that men generally tend to care less about them. This, however, does not mean all men do and there is one mouth change that even most men will eventually dislike…the downturning of the mouth corners.

Case Study: This 68 year-old male was bothered by his mouth appearance. He felt his upper lip was too long and he particularly disliked his mouth frowns. He felt that people viewed him as being angry and unpleasant…when he was not really that way. He felt that people saw him as unapproachable and unfriendly because is mouth at rest had a frown.

Male Subnasal Lip Lift and Corner of the Mouth Lifts drawings Dr Barry Eppley IndianapolisUnder local anesthesia, a subnasal lip lift was initially performed. His upper lip length along the philtral columns was 20mms. This was reduced by 6mms to 14mmw, a more normal upper lip length. Corner of the mouth lifts were performed using the pennant technique. An 8mm lift was done with skin excision and orbicularis muscle plication. This also had about 2 to 3mms of a  mouth widening effect at each corner.

Male Subnasal and Corner of Mouth Lifts immediate result Dr Barry Eppley IndianapolisMale Subnasal Lip Lift and Corner of the Mouth Lifts immediate result Dr Barry Epley IndianapolisThe thicker beard skin of men makes lip lifts and corner of mouth lifts more favorable in their scar formation than women. Such perioral rejuvenation procedures can work well for men as long as they are not overdone. (over lifted) The other potential adverse scar formation is that with corner of the mouth lifts…but this potential revisional issue is the same for both men and women.

Highlights:

1) Aging of the male mouth consists of upper lip lengthening, thinning of the upper lip vermilion and downturning of the mouth corners.

2) A subnasal lip lift in a male rejuvenates the lip-nose relationship and is an important part of many male mouth rejuvenation efforts.

3) A corner of the mouth lift in a males strives to achieve a neutral or unfrowning mouth appearance.

Dr. Barry Eppley

Indianapolis, Indiana

Surgical Techniques for Mouth Asymmetry

Friday, November 6th, 2015

 

Asymmetry of the mouth is not rare and consists of differences in the size and shape of the vermilion and/or the corner of the mouth. One side of the upper lip may be smaller than the other side or the corners of the mouth may be at different horizontal levels. Some patients affected by mouth asymmetry have had it since they were born while others have developed it with aging. Certain medical conditions that affect facial nerve function can also create mouth asymmetry with decreased muscular movement on one side.

The most effective method of improvement in mouth asymmetry, not caused by a nerve dysfunction, is a direct one. Moving the location of the vermilion-cutaneous junction through skin excision is the most visually effective technique. Lifting the skin from distant locations is not going to lift the mouth or improve lip symmetry. No form of a facelift or midface lift is going to affect the mouth area. This is well known in facelift where efforts to lift up drooping corners of the mouth is not successful.

Direct excision for improvements in mouth asymmetry are simple variants of the well known procedures of lip or vermilion advancements and corner of the mouth lifts. These direct excisional methods have been around for decades. Their effectiveness at cosmetic enhancements of the lip and mouth area can not be denied but they have never been widely popular due to the risk/concern of scarring.

Mouth Asymmetry Surgery result Dr Barry Eppley IndianapolisFor upper lip asymmetries a smaller side of the lip can be advance upward by a partial vermilion advancement that only goes as far as the cupid’s bow on that side of the lip. This can be combined with an extension into a corner of the mouth lift to create a complete elevation of the lower or hanging side of the mouth. While fine line scars are always a trade-off, they usually heal well when well executed even in high risk patients with intermediate pigment types. (e.g., Hispanics, Asians)

While not appropriate for everyone with mouth asymmetry, utilization of simple and direct procedures such as vermilion advancements and corner of the mouth lifts can be both effective and have acceptable scar lines.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Case Study: Corner of Mouth Lifts with Perioral Mound Liposuction

Wednesday, May 28th, 2014

 

Background: All areas of the face eventually show the signs of aging. But the mouth area in women is affected more by aging than that seen in men and is affected by sagging, thinning and wrinkling. The once fuller lips of youth give way to thinner lips with less vermilion show and vertical lip lines. The corners of the mouth turn down and jowling develops from the descent of tissues from above. Collectively put together this creates an older and unhappy mouth appearance.

While many plastic surgery procedures exist to treat the aging face, the most recognized ones do not have any influence on the mouth area. A facelift is a great procedure to improve the neck and jowls but does not affect the more central mouth region. Cheek lifts improve midface volume and sagging but will not turn a frown into a smile.

An aging mouth can only be improved by a direct approach and not peripheral pulling or lifting. This requires a series of different small procedures performed directly on the various aging mouth issues. Corner of the mouth lifts, laser resurfacing, lip lifts and advancements, lip volume augmentation and perioral mound liposuction all make up a collection of procedures under the category of perioral rejuvenation.

Case Study: This 57 year-old female wanted to improve the look of her mouth. She felt it looked old and constantly frowned. The corners were turned down and she had moderate jowling and fullness to the side of her mouth. She had excellent lip volume for her age and good skin with very few vertical lip wrinkles.

Corner of Mouth Lift with Perioral Mound Liposuction Dr Barry Eppley IndianapolisUnder general anesthesia (she was having numerous other facial procedures), she had a corner of the mouth lift combined with perioral mound liposuction.  The corner of mouth lift was performed using a small triangular cutout of skin obliquely oriented along the depressed mouth corners. Through a small mucosal incision just inside the corners, a 2mm cannula was used to remove 1.5ccs of fat from each perioral mound area down to the jowls.

Corner of Mouth Lift with Perioral Mound Liposuction result oblique view Dr Barry Eppley IndianapolisThese small mouth-related procedures produced a subtle but visible change in the appearance of her mouth giving it a more pleasing and youthful appearance. The smile line was now level and the convexities (bulges) on the side of the mouth were turned into more shapely concavities.

Corner of Mouth Lift with Perioral Mound Liposuction fersult side view Dr Barry Eppley IndianapolisThe relatively obscure corner of the mouth lift  has been around for over 75 years and, despite its simplicity, is the only procedure that can produce a permanent improvement for downturned mouth corners. It is a very small area of skin excision but it has to be marked out and executed very carefully to avoid visible scarring. Even when done well, there is a 20% to 30% incidence of minor touchups to the scar(s). Perioral mound liposuction is even less well known but less than 2ccs of fat removal can get rid of undesireable fullness and tissue sagging.

Case Highlights:

1) Aging of the mouth causes a variety of changes including downturning of the corners of the mouth, lip lines, marionette lines and jowling.

2) Perioral rejuvenation includes a variety of procedures including correction of frowning with a corner of the mouth lift.

3) Perioral mound liposuction can help get rid of the sagging fullness to the side of the mouth.

Dr. Barry Eppley

Indianapolis, Indiana

The Corner of the Mouth Lift For the Sad or Aging Mouth Correction

Friday, January 31st, 2014

When it comes to treating the aging face, most everyone immediately thinks about a facelift. While a facelift can be a variable concept depending upon how it is done, many patients assume that it is an effective cure for all parts of the face including the mouth. The reality is that lifting the downturned corners of the mouth is almost completely unaffected by a facelift…and trying to do so will likely create a very tight and unnatural facelift result that will leave the patient disappointed.

The reason a facelift can not change the sagging mouth corners is two-fold. First, the point of pull is simply too far away to be effective. The distance between the ear and the corner of the mouth is too distantly separated. Secondly and equally important is that their vectors are completely perpendicular to each other. The sagging corner of the mouth drops vertically, while a facelift pulls tissues laterally. A negligible pull from the wrong vector equals no improvement.

The corner of the mouth lift represents a simple but highly effective method for changing the downturned or sad mouth corner. It works because it attacks the problem directly, affecting its position directly over the problem and in the right vertical or upward direction. Its simplicity is matched by its effectiveness whether done in isolation or as part of a more extensive facial rejuvenation procedure.

Corner of Mouth Lift Design Dr Barry Eppley IndianapolisIn the November 2013 issue of the Archives of Plastic Surgery, an article appeared entitled ‘Descended Mouth Corner: An Ignored But Needed Feature of Facial Rejuvenation’. In this article, the descended mouth corner lift, also known as an anguloplasty, is presented. The authors treated 71 patients using the corner of the mouth lift technique with consistently good results, with just one requiring revision. They conclude that this procedure by itself and in combination with other small operations or even a full face lift can help rejuvenate the aging mouth area.

Corner of Mouth Lift in Indianapolis by Dr Barry EppleyThis is one of the few articles in the medical literature that has written about a mouth lifting procedure that has been around for decades. I would corroborate most everything the article has to say about the corner of the mouth lift with the exception of the number of revisions. Even though it is a very small procedure in surface area, it does create a scar line that goes slightly beyond the vermilion tissue of the mouth corner. While not usually an issue in older patients, some occasional scar touchups may be needed in younger patients with less tolerant skin.

Dr. Barry Eppley

Indianapolis, Indiana

Patient Testimonials: Corner of Mouth Lift

Saturday, November 2nd, 2013

Corner of Mouth Lift

‘Thank you very much for my corner of mouth lift. My mouth has changed now. I came home from United States last week and my friend saw me with my new mouth and she was amazed. She said to me that my mouth is marvelous and is much better now. She was happy and told me that my smile  is much improved. A big thank you for the operation on my mouth corners. I am very happy and am feeling much better as my mouth was getting very droopy in the past few years.’

Gwen H.

United Kingdom

Commentary

While many plastic surgery operations make big changes in how one’s face looks, few operations that are so small can make such a big difference as the corner of the mouth lift. The mouth that turns down, either from how it naturally developed or from aging due to the descent of surrounding tissues, makes one look sad or even mad. This appearance is usually quite contradictory to how one actually feels but the droopy mouth corners create that impression nonetheless. While Botox and injectable fillers can help push up the downturned mouth corners they offer only temporary fixes…and if not done well the mouth lifting effects can be less than desired. A corner of the mouth lift offers a permanent fix to the sagging mouth corner by removing the skin overhang and changing the position of the mouth corner (commissure) upward. Small scars at the corner of the mouth result from the lift but, if well placed and not overdone, they are not a long-term aesthetic issue. When done as a stand alone procedure, corner of the mouth lifts are done as an office procedure under local anesthesia.

While the corner of the mouth lift seems new, it is really an old procedure that was done long before Botox and injectable fillers were even in development. When there was no other way to change the corner of the mouth but skin excision, the old’ valentine’ corner of mouth lift was done. (the skin excision pattern was shaped like a heart)

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Surgical Rejuvenation of the Aging Mouth

Wednesday, October 16th, 2013

 

Background: Aging affects all parts of the face and the mouth area is no exception. The changes of the lips and the perioral tissues are classic and include thinning of the lips, downturning of the corners of the mouth and the development of vertical lip lines. These central facial aging changes are unaffected by more peripheral procedures like a facelift. Rather they require a direct approach to their treatment and are not uncommonly done as part of a facelift to provide a more complete facial rejuvenation effect.

While injectable fillers are the mainstay of younger lip and mouth enhancements, the older aging mouth is less responsive to just pure plumping effects. It needs more help with actual mini-lifting prcedures that are designed just for the lips.

Case Study: This 62 year-old female was bothered by the constant frown of her mouth and the thinning of her upper lip. While she had always had a thinner upper lip, it had gotten even thinner as she has gotten older. Her goal was not to have really big lips but an upper lip that matched the size of her lower lip. But what really bothered her was the downturned corners of her mouth. This made he look mad all the time when she really wasn’t.

A lip rejuvenation plan was marked out that included an upper lip (vermilion) advancement, corner of the mouth lifts and fat injections into her marionette lines.

Under local anesthesia which included infraobital nerve blocks and direct local infiltration into the upper lip, a 3mm vermilion lip advancement was initially done with making the cupid’s bow area more accentuated. The tail ends of the vermilion advancements were left open in preparation for the corner of the mouth lifts. Corner of the mouth lifts were done by making an outward line of 7mms from the corners toward the tragus and turning that into a triangle as it curved toward open end of the lip advancement. Finally, fat was harvested from her abdomen from inside her bellybutton, concentrated and then injected from the bottom end of the marionette lines upward, placing 4ccs of fat per side.

There are many options for turning an aging or unhappy mouth area into a more rejuvenated one. While the most common technique that comes to mind are injectable fillers, they usually are inadequate for older lip and mouth area as the exclusive treatment option. To make lips fuller or to change the smile line in older patients requires skin removal and lifting techniques.

Case Highlights:

1) Lip and perioral aging is often accompanied by a combined thinning of the upper lip and downturning of the corners of the mouth.

2) Corner of the mouth lifts combined with an upper lip advancement creates a more complete lip rejuvenation effect.

3) Most perioral rejuvenation procedures can be performed under local anesthesia as an office procedure.

Dr. Barry Eppley

Indianapolis, Indiana

The Global Differences in the Corner of the Mouth Lift

Wednesday, August 21st, 2013

 

Much of one’s facial expression has to do with the mouth or perioral area. While there are over 10,000 different facial expressions, most can be lumped into six major categories. One of these categories of major facial expressions is smiling of which the mouth plays a major role. Everyone knows that an upturned smile line conveys happiness and a downturned frowning one is unhappiness.

The lip line at rest is usually seen as a straight horizontal line with the corners of the mouth being level. Whether it is by aging or one’s natural mouth development, some people develop a downturning of the corners of the mouth creating a constant frown and an undesired mouth appearance. While many perceive that a facelift can lift up the corners of the mouth, this is not true as the point of the tissue pull is just too far away. Injectable fillers can create some uplifting of the corners of the mouth but the effect is not sustained and usually only of a minor improvement.

The one proven procedure to uplift or level out a frown is the corner of the mouth lift. This very simple procedure works because it removes tissue directly at the corner of the mouth and changes the position of the lateral commissure. It was described many decades ago and has been called the Valentine Anguloplasty procedure based on the shape of the skin cutout. It works so well that the plastic surgeon must be careful to not overdo it (which is very easy to do) lest the patient is left with a permanent joker’s smile.

A recent internet report out of Asia talks about the growing trend of the ‘mouth corner lift surgery’. They describe a procedure that is identical to the well known corner of the mouth lift. They give it the name ‘Smile Lipt’ because it not only lifts up downturned mouth corners but leaves one with upturned curls for a permanent smile effect. They provided the following before and after pictures to illustrate the effect of the ‘Smile Lipt.’

While some question whether these pictures are for real, they most definitely are. One of the telltale signs of a corner of the mouth lift are small scars on the skin outside of the vermilion or red part of the corner of the mouth. These scars are difficult to hide particularly in thicker Asian skin. Careful inspection of the skin outside of the corners of the mouth in the pictures shows the scars.

Such upturned mouth curls may be a desired fashion trend in Asia, but in America this is exactly the result one wants to avoid from a corner of the mouth lift. They may be cute mouth curls in one part of the world but a undesired joker’s smile in another.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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