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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.


  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

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