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A frowning look is not associated with the perception of happiness nor youth. A frown is primarily a result of the angulation of the corners of the mouth. The mouth corner is where the upper and lower lips meet and should be at the same horizontal position  as the lip line. (the line where the upper and lower lips meet from one side to the other) For some people, they have a natural downturn of the corners. Most downturned mouth corners, however, are the result of aging. As the skin and deeper tissues above the relatively static lips fall, the corners of the mouth are often forced downward.

When the corners of the mouth droop down, the lip line gets a gentle convex arc This convex arc often turns into a vertical gutter at the sides of the chin. These are known as marionette lines which are likewise caused by the descending jowls folding over the fixed chin tissues. Downturning of the mouth corners and marionette lines usually go together for most aging patients.

No type of face lifting procedure will move the corners back up to a horizontal position. Whether the pull comes from the direction of the ears (facelift) or from the direction of the corners of the eyes (midface lift), the corners of the mouth will be relatively unaffected.

The best method to change the orientation of the corners of the mouth is directly. By removing a simple modified triangle of skin, the corner angle is moved upward. This simple procedure, known as the corner of the mouth lift (COML), is very powerful at changing the lip line. It does result in a small incision line that goes horizontally outward from the corner, but this almost always heals well with minimal scar. The key to the COML is not to remove too large of a triangle of skin as this can cause the mouth corners to turn up or out too far, resulting in a joker’s smile deformity.

The COML can be easily done in the office under local anesthesia. In my Indianapolis plastic surgery practice, I often combine it with the use of injectable fillers to lessen the marionette lines inferiorly, the nasolabial folds superiorly, or with simultaneous lip enlargement. It is also not uncommon to perform it with other major surgeries such as facelifts. The COML is a little â nip and tuck that is a valuable part of the numerous procedures that can be done for perioral rejuvenation.

Dr. Barry Eppley
Indianapolis, Indiana


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