Q: Dr. Eppley, I am bothered by my downturned corners of my mouth. It makes me look sad even though I am not. I am tired of people asking me if I am sad or mad. My mouth has a bit of an upside down U-shape to it. I just need my smile line leveled out like it used to be. What are my treatment options?
A: The downturning of the corners of the mouth primarily occurs due to the tissues above it falling downward. As the cheek tissue above the nasolabial fold descends with age and gravity, it pushes the corners of the mouth down with it. This creates the classic smile inversion and the expression of sadness. The muscles around the mouth, particularly the depressor anguli oris muscle, can also contribute to pulling the corners down. Contrary to popular perception, a facelift will not lift up the corners of the mouth. The problem must be treated, not from a distant pull of skin.
The arc of the smile line can be improved by two methods. The most common approach is the injectable approach. By adding volume to the tissues underneath and under the mouth corners, a definite lifting effect can be seen. The best injectable fillers to use for this are hyaluronic-acid based such as Restylane or Juvederm. Adding Botox or Dysport is also helpful because it weakens the depressor muscle and will cause the unopposed lip elevator muscles to pull the corners up. These injectable effects can be subtle and will only last as long as that of the materials used. A more permanent and dramatic effect can come from an actual corner of the mouth lift. By removing a small triangle of skin from just above the mouth corner, the commissure is actually repositioned upward. This is a simple procedure that can be performed in the office under local anesthesia.
Dr. Barry Eppley