There are many structures of the face which contribute to its shape and proportions. Some of these are seen by their vertical relationships while others are seen more by their horizontal dimensions. The lips contribute to facial appearance by both their vertical and horizontal size of the exposed dry vermilion. Many aesthetic treatments are available to increase the vertical size of the vermilion from synthetic fillers, fat injections, implants to surgical relocation of the vermilion-cutaneous border.
The horizontal size of the lips, also known as the width of the mouth, can only be changed by surgical relocation. The most common horizontal change in the size of the mouth is to make bigger or wider. By anthropometric measurements the corners of the mouth should ideally be at the width at a vertical line dropped down from the pupils of the eye. For those who like a Golden Ratio assessment the mouth width should be 1.6X the width of the nose. (bialar distance)
Widening of the mouth can be done by a commonly applied soft tissue rearrangement technique of a Y-V advancement. The desired location of the mouth width is marked and should not be greater than 5 to 7mms from the natural vermilion-cutaneous border of the mouth corner. Triangular lines of skin excision are made above and below this horizontal line for purposes of adding vermilion width to the new mouth corner. If not done the extended mouth corner will just appear as a narrow line. This is the equivalent of drawing two opposing arrows at the side of the mouth.
Another key step is the removal of a wedge of orbicularis muscle. This provides space to move the full thickness of the mouth corner into its new lateral position. Without muscle removal only the overlying vermilion is moved and the muscle will push back increasing the potential form relapse.
Closure is from deep to the surface is multiple layers with small resorbable sutures. The only postoperative restriction, which will be obvious, is to limit extreme mouth opening for a few weeks after the surgery.
Mouth widening employs skin excision with the use of a well established tissue rearrangement technique oif Y-V advancement. It is more common to use the reverse, a V-Y advancement, in tissue reconstruction of skin defects. But the principle is the same in terms of tissue relocation/lengthening. The question with mouth widening is never whether it is effective but how does the scar at the mouth corners turn out. The vermilion at the mouth corners is uniquely different than that along the rest of the upper and lower vermilion-cutaneous border. It is thinner and is exposed to postoperative stretch that is greater than the rest of the vermilion border. So the risk of adverse scar formation is very real and one should always anticipate that secondary scar revision may be needed…but hope that it is unnecessary.
Dr. Barry Eppley
World-Renowned Plastic Surgeon