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Downturning of the corner of the mouth is a frequent aesthetic request for change. While most commonly associated with aging some people have it as a natural shape of their mouth. In my experience it occurs more commonly in people who have a horizontal smile pattern as opposed to a superior-oblique pattern regardless of their age.

Non-surgical techniques exist for helping the sagging mouth corners an include Botox and injectable fillers. Botox decreases the downward pull of the depressor lip muscles while fillers provide an upward push on the mouth corner. While effective for more minor amounts of downward sagging the effects are temporary and don’t work that well when the downward angulation of the mouth corners are more severe.

Like all surgical facial rejuvenation surgeries mouth corner lifts have been around for a long time. Various skin excisional patterns have been described either done directly at the mouth corner or along the nasolabial folds. The primary objectives of mouth corner lifts are to create an effective change (at least make the mouth corners level) and minimize the scarring as much as possible.

The key to decreasing the scar risk is to keep it limited to the vermilion-cutaneous junction of the mouth corner. Any excisional pattern which creates a scar pattern that leaves the vermilion-cutaneous junction and creates a scar out onto the skin should be avoided. This is why I prefer the technique that I have developed known as the pennant corner of mouth lift. What makes this technique different from others is that it uses a back cut which extends along the vermilion-cutaneous junction of the lower lip. 

This vermilion-cutaneous back cut allows the mouth corner to then be mobilized and then moved (transposed) into the defect left by the pennant shaped skin excision. Muscle manipulations inside the open mouth corner area may include orbicularis wedge excision with superior suspension.

With closure all scars remain along the vermilion-cutaneous junction. Based on the angle of the marked pennant skin excision the mouth corners will be both uplifted as well as a bit wider. The angle of the pennant pattern will also influence whether the mouth corners become level or have a slight upward tilt.

When done in isolation it is a procedure that can be comfortably performed under local anesthesia. It is often done as part of an overall facial rejuvenation/reshaping surgery as well. 

Dr. Barry Eppley

Indianapolis, Indiana

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