Downturning of the corners of the mouth can occur from aging or as part of a natural mouth shape. Regardless of its origin downturned mouth corners are not a desirable mouth shape as it conveys an impression of unhappiness or even appearing angry or mad. The most common form of lifting of the downturned mouth corners are injectable Botox and filler treatments. Botox injections weakens the depressor muscles to counteract any downward pull on the corners and fillers act to lift the corners by the upward push of the injected volume.
Surgical corner of mouth lifts are done far less commonly than injection treatments but do offer a more permanent solution. Their effectiveness is based on the removal of overhanging skin and muscle tissue with an upward repositioning of the mouth corner. They have been around for a long time but have never gained much traction with surgeons or patients due to lack of familiarity and the fear of adverse scarring. Injection treatments offer immediate results without surgery even if the amount of lift is much more limited.
Corner of mouth lifts have traditionally been done using a heart-shaped or ‘valentine’ pattern of skin excision with a resultant scar line that runs into the facial skin away from the vermilion edge of the mouth corner. While effective I have never liked that technique due to the scarring and the high rate of scar revision from it. As a result I have developed and used for years the Pennant Corner of Mouth Lift method. This is really a transposition technique where the excised skin area is inset by the mobilized and repositioned mouth corner. This prevents any scar line from being outside of the vermilion-cutaneous border. This is possible because of the natural flexibility of the vermilion lip tissue.
The pennant pattern of the markings is created by the triangular segment of skin above the mouth corner to be excised with a back cut along the lower lip margin. Once the skin is excised a wedge of orbicularis muscle can be removed and the muscle lifted and tightened. Then a back cut is done along the lower lip vermilion border which allows the mouth corner to be mobilized and inset into the area of skin excision. This then keeps all the scar lines along the vermilion-cutaneous edges of the mouth corner.
While keeping the scar line restricted to the vermilion edges of the mouth corner does not ensure that a scar revision would never be needed, but it keeps it limited to an area that is far more favorable to acceptable scarring than outward onto the facial skin.
Dr. Barry Eppley