The mouth occupies the center of the face and is a prominent facial feature. The mouth is well is known to be a sensual structure whose perception is primarily influenced by the size of the lips, particularly in females. As a result, lip augmentation usually by injection is the most aesthetic procedure performed in the mouth area. Surgical lip manipulations include increasing or decreasing the vermilion show through subnasal lip lifts and advancement procedures.
The corner of the mouth is the smallest part of the lips but can still be surgically manipulated. This is usually for the aging mouth with downturned corners through a corner of the mouth lift. This is usually done in patients which, although often done in isolation, is also done during facelift surgery as well.
One other procedure done at the corner of the mouth is to adjust its width, the least commonly performed of all aesthetic mouth surgeries. Through adjustment of the position of the vermilion-cutaneous junction the mouth can be widened. From an aesthetic standpoint, the width of the mouth should be equal to or just within vertical lines dropped down from the inner edge of the iris of the eye. (although it is often closer to a vertical line dropped down from the pupil) From a facial proportion viewpoint the width of the mouth is described as being 1.6 times the width of the bottom of the nose as per the Golden Ratio.
In mouth widening surgery, the patient is first marked by establishing the target with a vertical line drawn down from the pupils of the eye. A horizontal line is the drawn from the vermilion-cutaneous junction at the mouth corners out to that line. This horizontal line often measures anywhere from 5 to 7mms. Triangles are drawn from the target width on each side of the horizontal line up to the vermilion border of the upper and lower lip.
An incision is first made from the mouth corner out to the desired width. The triangular skin segments (technically an hypotenuse) were next removed on each side. (total of 4 skin segments) To allow the mouth corner to move out to fill his created gap a wedge of orbiculares muscle is removed from each side.
Lastly the mouth corner is advanced out and a two-layer closure is done to complete the widened mouth corners.
Mouth widening surgery is a very effective procedure at opening up the small mouth.To have the best aesthetic result the advanced vermilion edges must be rolled outward with the widening and some muscle removed to create the space to do so. Fine line scars are the trade-off of mouth widening but they usually heal well and are acceptable. But some patients may require a small scar revision based on how well they heal.
Dr. Barry Eppley
Indianapolis, Indiana