Development facial asymmetries are common and often involve more than just one facial structure.One of the structures often involved in more complete facial asymmetries is the corner of the mouth. The mouth corner is frequently in some facial asymmetries, usually in the 3 to 7mms range. This creates an obvious cant to the smile line. (horizontal line drawn between the two mouth corners)
The asymmetric mouth corner can be corrected by a specific corner of the mouth lift technique. But it is important to recognize that the corner asymmetry extends well beyond the corner. The entire upper lip vermilion almost to the ipsilateral cupid’s bow is lower. As a result an extended corner of mouth lift is needed. Essentially the elongated section of upper lip skin that needs to be removed looks like a stretched out pennant flag. It is also important to back cut the bottom of the pennant down onto the lower lip vermilion a bit to allow for adequate mouth corner mobilization to move up into the lateral corner of the excision.
The extended mouth corner lift can be performed under local anesthesia (if done by itself) or under general anesthesia if multiple other procedures are being performed. The marked area of skin is excised and the mouth corner undermined with the small back cut to allow for adequate mobility to be transposed superiorly. It is not necessary to remove any orbicularis muscle.
Once mobilized the mouth corner is transposed into the outer corner of the excision and the rest of the vermilion is advanced toward and closed into layers of dermis and skin.
The extended corner of mouth lift is very effective at leveling out the smile line in facial asymmetry. There is the tradeoff of a fine line scar at the vermilion edge which interestingly usually does well particularly in men due to the hair bearing skin.
Dr. Barry Eppley