Q: Dr. Eppley, I am interested in a mouth widening surgery procedure.I have a VERY small mouth. It is of equal width of my nose (my nose is thin). I have read your concerns about post surgery scarring with this procedure and I think that for me personally, the benefits tremendously outweigh the risks. But I guess that’s for you to decide. I just have a couple of questions though first. How prominent are the scars? And can they be removed through either permanent makeup or steroid injections? I read that you said this procedure is easy. Please contact me when you can because your one of the only surgeons who is qualified enough to perform this. Thanks!!
A: A mouth widening surgery procedure (opening commissuroplasty) is a limited procedure and not difficult to undergo given that the corners of the mouth are small in size. The fine line scars are placed at the junction of the skin and vermilion around the corners of the mouth. Should the scars heal unfavorably, they will not be effectively treated by steroid injections or makeup, they will require re-excision and closure. (surgical scar revision) You should not think of scars being ‘removed’, they can be reduced but never completely removed. You are correct in your assumption that one’s mouth width (corner to corner) should exceed the width of the lateral ala when vertical lines are dropped down past the mouth. By ideal proportion standards, the width of the mouth should be 1.618 that of the width of the nose.
Dr. Barry Eppley
Q: Dr. Eppley, Hi. I have a few queries about possible procedures which may enhance my smile and lip shape. First of all, I have quite a small mouth, as in the horizontal distance from corner to corner of my lips is quite short, and therefore my mouth at rest is small and my smile does not show many teeth. Is there any procedure, such as lip lengthening, which can make my mouth opening wider- hence make the horizontal distance of my mouth at rest longer, and to make my smile wider? My next issue- which I think is related, is that my top lip covers quite alot of my top teeth when smiling, and also I would like my top lip to be more outturned or ‘pouty’. Is there a surgery which can reduce the distance between the nose and the lip to reveal more vertical distance of the teeth when smiling, and to achieve a more “pouty” shape? I’m not sure if it would help to send photos, but I can if that is needed. Thank you in advance!
A: What you are seeking is a horizontal widening of the corners of the mouth and a vertical shortening of the upper lip. There are surgical procedures for each of those changes. The upper lip can be vertically shortened, the upper lip become more pouty and more upper teeth can be shown through either a subnasal lip lift or an upper lip vermilion advancement. Which one is better for you would depend on seeing a picture of your lower face for my assessment and what location of scar would be preferable. (under the nose or along the vermilion-cutaneous border) The corners of the mouth can be widened through a commissuroplasty procedure where a v-shaped segment of skin is removed (about 5 to 7mms per side) and the corner vermilion advanced outward on each side. Whether that fine line scar around the corners of the mouth is acceptable would be the concern.
Dr. Barry Eppley
Q: Hi Dr. Eppley, I don’t like the look of my mouth. Can you help me to look like every other normal people and to make my mouth so that it isn;t so big. Because now I look like a monkey. I really don’t like my look and nobody else likes it either. Please send me a picture if you can do something about me. Big thanks!
A: Thank you for sending your pictures and stating your concerns. What you are referring to is known as macrostomia. This is where the horizontal length of the mouth, from one corner to the other, is too long or wide. Technically, the upper and lower lips are too long but it is where they join (called the commissures) where the mouth width is judged. By standard anthropometric measurements (created largely from Caucasian study populations), the width of the mouth should not exceed a vertical line drawn down from the pupil of the eyes. While this is a measurement it has to be taken in perspective of the patients overall facial aesthetics to determine if it is really abnormal or bothersome. It can seen in your one frontal photograph that your mouth corners extend beyond this area.
An excessively wide mouth can be horizontally shortened through a procedure known as a commissuroplasty or corner of mouth tuck. While this is more commonly used in the treatment of the reverse mouth problem, microstomia (too small a mouth), it can be used to make a wide mouth more narrow. While this could easily reduce your mouth width by 5 or 6mms a side (reducing total mouth width by a cm.), there is a trade-off of a fine line scar that goes a short distance in the skin outward from the corner of the mouth. One has to consider this scar trade-off carefully.
Dr. Barry Eppley