Your Questions
Your Questions
Q: Dr. Eppley, I am interested in a corner of mouth lift. I have had fillers and Dysport to lift the corners of my mouth. I don’t believe the doctor who did my filler placed it right. I have a puffy place then it goes flat and it didn’t raise the corners of my mouth at all. I spent a lot of money to get that done. I was wondering if you think a corner of the mouth lift would help and how much does it cost. I am 48 years old. Thank you.
A: While injectable fillers and neuromuscular modulators can have a positive effect on the corner of the mouth, it depends on what the original problem was (how severe is the corner of the mouth droop) and what type of change (corner of mouth lift) one was looking to achieve. Your result may be a function of an incorrect treatment for the problem (mouth corners to severely sagged) or the correct treatment that was not ideally done. I can not say which led to your post-treatment results. I would need to see pictures of your mouth area to determine what is the best approach now.
What I can say is that a corner of mouth lift is the single most effective method for changing the shape of the corners of the mouth that produces a more profound and sustained result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Can you answer a technical question about lip lifts? Is there a difference between a corner mouth lift (smile surgery) and corner lip lift? Do you perform these type of lip lift surgeries?
A: In answer to your questions, a corner of the mouth lift and a corner lip lift sound very similar but there is a subtle difference. A corner of the mouth lift evens a downturned mouth corner by removing a small strangle of skin just outside of the mouth corner. A corner of the lip lift creates more visible vermilion at the tail of the upper lip (and can be combined with a corner of the mouth lift) by removing a small strip of skin kist above the lateral vermilion lip edge. Some people only need a corner of the mouth lift while other people only need a corner lip lift. Then there are some people who need a combined corner of the mouth lift combined with a corner lip lip lift because their whole side of the lip is turned down. I have performed a lot of both of these and you have to pick the right procedure for the lip problem. Often times I see patients who had the wrong type of lip lift performed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have an unusual question. I know you are an expert at the corner of the mouth lift. My lips turn up at the sides too much as it is. Is there any way you could perform a subtle corner of the mouth ‘drop’…a reverse corner of the mouth lift if you will. This would be a reverse procedure. When I pull my lips down slightly they look as good as possible and being a professional entertainer I could really use this improvement. Also can the lower lip be lengthened slightly– thank u so much for your time!
A: I have to admit that I have never done a ‘reverse’ corner of the mouth lift nor has anyone ever requested it before. But like a traditional corner of the mouth lift, the reverse can be done I am sure. Some lengthening of the lower lip could be done at the same time. Unlike the corner of the lift which is done on the upper lip, a corner of the mouth ‘drop’ would be done on the lower lip.
I would need to see pictures of your mouth to give a more qualified opinion.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a lip corner uplift. The ends of my mouth are drooping and I wish to enhance the corners of my mouth so I don’t look depressed, when I am not! I have attached a picture of my droopy mouth for you to see what I mean. Thanks
A: A corner of mouth lift is the only surgical procedure that can change the inverted U-shape lip line into a straighter one. Injectable fillers can help provide some corner of the mouth lift but its effects are limited and only temporary.
While there is no question you would benefit from a corner of mouth lift, I do have some concerns about the small scars that result given your skin pigmentation. The most effective corner of the mouth lifts (traditional triangular excision) do leave some small linear scars that radiate outward from the corners of about 7mms. The other corner of the mouth lift technique is the ‘pennant method’ where all scars remain at the vermilion-skin border but it does not lift the mouth corners as much.
Given your Hispanic ethnicity I would tend to choose the pennant corner of mouth lift method so as to keep the scars at the vermilion-cutaneous location. I would accept the trade-off of a less result to reduce potential scar issues.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, The corners of my mouth sometimes bleed and droops. Is there anything I can do for this? I LOOK unhappy. I don’t want to use needles and does medical insurance pays for this.
A: A downturned corner of the mouth can create more than a frowning or unhappy look. By acting as a salivary spillway, it can create chronically irritated tissue and yeast infections. This can make the corners of the mouth both red and prone to cracking and intermittent bleeding.
By your symptoms it sounds like you would benefit by a corner of the mouth lift. This is a procedure done under local anesthesia to lift the corners of the mouth by removing a triangle of skin from the overhanging portion. I would need to see a picture of your mouth to verify that this procedure can be helpful. It may or may not require more than a corner of the mouth lift to be successful which I can determine by a picture. (possible nasolabial fold excision as well) These mouth lifting procedures are not covered by medical insurance.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I recently had a subnasal lip lift which I am pleased with the lift in the center of my lips. Now however, it seems to accent the thin corner of my liplips. Aesthetically to balance out the look, I think this is something that should have been done too. Can a corner lip lift be done with local anesthesia?
A: The subnasal lip lift in the right patient is a very effective lip augmentation procedure but it will only affect what lies within the skin excision pattern. By dropping down a vertical line from the sides of the nose to the lip, the lip area improved will only lie within. In essence, it shortens the amount of vertical skin between the base of the nose and the upper lip and only provides accentuation of the cupid’s bow of the upper lip. It would not be rare to a have a lip lift patient turn their focus to the sides of the lip and the mouth corners thereafter.
The key question about changing what was not improved by the lip lift is defining the exact area of outer lip deficiency. This could be either an isolated corner of the mouth lift or an extended corner of the mouth lift that extends further up along the sides of tails of the upper lip. This distinction is critical to understand. An isolated corner of the mouth lift will just change the angle of the corner of the mouth and will not make it thicker. A extended corner of the mouth lift or an outer lip advancement will make the sides of the lip fuller.
I would need to see a picture of your lip to help you decide what is the correct lip augmentation procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to explore a lip lift and corner lip lift. I have an unusually long upper lift (distance from bottom of nose to top lip) and would look much more balanced if that distance could be shortened. However, I have an over rotated upturned nose from previous rhinoplasty. This means there is no crease or space in the shadow of a nose that a scar could hide and it would mean that if there was nostril distortion, it would be very visible and unattractive. Given how little room for error my nose allows for this lip lip and corner lip lift, should I consider this surgery or let it go?
A: When it comes to a subnasal lip and corner of the mouth lifts, the most important issues are the potential scars and not overdoing either type of lift. Prominent scars or an overcorrection (which is virtually impossible to correction since you can not add back skin) are aesthetic tradeoffs that one needs to avoid. While I have not seen a picture of you, you may have answered your own question…if there is little to no room for error…why take the chance? I have never seen nostril distortion and have only rarely revised a subnasal lip lift scar but your concerns do have merit.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have always had a long upper lift, and a downturned mouth, causing people to think I’m sad or annoyed, when I’m simply feeling neutral. As I have aged (over 40 now), the downturn has become more pronounced, and in the last year, I’ve started to have problems with the seal in the corner of my mouth being imperfect–leading to drooling at night, and occasional infections in the corner of my mouth. I am interested in a corner of the mouth lift–but am not concerned about the asymmetry in my vermillion, or the longer top lip–just the corners. I have a fabulous smile, and would hate to have anything change it!
I am also a very “moley” person–with new moles popping up every year…and have at least one, almost pencil eraser sized one that I would like removed–and possibly a cluster of four, on the other side of my face, as well. I’m looking for your opinion as to the advisability of the mole removals (potential scarring), as well as a corner of the mouth lift. I am also working on losing weight–have lost 50 pounds so far, and have about 70 to go…I had originally wanted to wait until I lost all the weight until I did anything about this…but the mouth infections are making me push this forward a bit–do you think that additional weight loss would be a concern, in having this done sooner, rather than later?
I’m attaching two images–including all the moles–with the second one approximating the neutral/barely upturned mouth corners I’m hoping for–and with the moles removed.
Thank you for any help you can provide!
A: By your pictures and the imaged changes you have shown, that type of result from a corner of mouth lift is very realistic. I have usually found that the corner of mouth lift can improve or eliminate the yeast infections from the salivary wetness. Your weight, loss or not, has no bearing on the corner of the mouth lift procedure. (in other words there is no benefit to doing it after weight loss)
All of the facial moles you have can be removed with minimal scarring. Given their raised non-melanotic appearance, I would not routinuely send them for pathologic evaluation as nothing about them makes them suspicious for any form of skin cancer.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to get a corner of the mouth lift. I am a 43 year old Asian female with no fold. I have a neutral corner of mouth, but I just want to have a happier mouth when I’m not smiling.
A: The corner of the mouth lift is traditionally done for aging in which the corners of the mouth are turned down. By removing a triangle of skin from just above the mouth corners, the lateral commissure point is moved upward. While it does produce a small scar (usually about 7mms in length) that tails away from the corner of the mouth, it creates a very noticeable change in the location of the mouth corners.
In the neutral or non-downturned mouth corner, such a lift creates upturned mouth corners also known as a ‘lip curl’. Such a mouth shape has become popular in Korea and Japan as a sign of a beautiful mouth shape. While imparting an upturned mouth is the opposite of what is desired in the Caucasian aging mouth, this is a modern day use of an older plastic surgery procedure for a more contemporary application.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in some lip augmentation procedures. My lips are getting thin with lines above them and the sides of lips are turning downward. So I would also want to have lip enhancement like implants which are permanent. And a treatment to reduce the lines above my lips. Can I have these procedures on the same day? I have attached some pictures of my lips close-up.
A: Your lip augmentation will require a composite of procedures to get the best overall result. You actually do have some reasonable vermilion height although the upper lip is thinner than the lower. Your upper lip is also very long. Putting these lip issues together the best approach for your upper lip is a subnasal lip lift (to shorten the length of the upper lip), lip implant (for permanent volume), extended corner of mouth lifts (to lift up the corners and to make the tail ends of the upper lip thicker) and laser resurfacing of the upper lip. (to reduce the depth and number of vertical lip lines) These combined lip procedures can be combined with a lower facelift which is commonly done.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have had three prior facelift efforts and none have been effective at giving me an upward look to my face that crrently looks pulled down. It’s been recommended to me that a MACS lift might help pull upwards somewhat without involving the same incisions around the ears from the 3 previous facelifts. (I’ve been told that opening previous incisions could be risky.) Does a MACS lift have to include opening up the previous incisions around the ears or could it somehow be done otherwise. I am trying to get rid of my ‘hound dog’ look to my mouth and the deep creases above my lips.
A: Having had three prior facelift type procedures, it should be obvious by now that any type of facelifting effort is not going to improve the central aspect of your face. That is simply not where the pull from facelifts have their effects. Facelifts never improve sagging around the mouth and deep nasolabial folds. Thus, not type of MACS lift or any other variation of a facelift that uses the ears as the location for the direction of pull will work. Your prior facelifts have not failed because they did not improve these central facial areas as they have donen a good job with your neck and jawline which is where they work teh best. You are going to need to consider other more direct procedures such as corner of the mouth lifts, midface lift or even direct nasolabial fold excision to get this part of your face looking as rejuvenated as the jawline and neck.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to get the upside frown surgery. Can you please tell me how much this would cost? How long would recovery take? Is the surgery painful? How long does it take to get an appointment?
A: Thank you for your inquiry. It appears that you have an ‘upside down froen’ issue. In looking at your pictures what i see in a level smile line but an overhang of the mouth corners turning into deep marionette lines. This is not a problem that will respond well to a more simple corner of mouth lift alone. While that will get rid of the overhang at the corners of the mouth it will not improve the deep marionette lines. That problem can be simultaneously treated with either fat injections or (ideally) a jowl line lift to pull back the tissues that are falling forward.
For the sake of providing some sort of a cost quote, let me for now assume it would be a combined corner of mouth lift with marionette line fat injections. I will have my assistant pass along the cost of that procedure to you later today. This is not a painful procedure with minimal recovery. (just some mild swelling) Surgery can be scheduled as soon as your schedule permits.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I live overseas and am interested to fly over and get the corner of mouth procedure as shown on your website. I have had many small surgeries so I am not at all apprehensive and understand more or less what will happen. The only request I have is will there be a scar?
A: While a corner of the mouth lift is a fairly simple procedure, it is important to understand that there may be a small outward scar from the corner of the mouth in most patients. In many cases I try and keep the scar to stay along the vermilion-cutaneous border (lip-skin border) particularly in younger patients. In looking at your pictures you will note that the downturned corner of the mouth is also associated with an upper lip vermilion (pink part of the lip) that completely tails off before it ever reaches the corner of the mouth. This is actually very common and indicates that it may need to be part of the solution as well. Thus the most effective corner of the mouth lift in your case is one where the skin removed also involves a vermilion advancement that encompasses the outer 1/3 of the upper lip border.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I had a craniotomy for an aneurysm over a year ago with radiation. This has left me with many effects from facial nerve paralysis. It has affected my face from the brow the whole down to the neck with a facial droop. I have attached pictures for your assessment. When I lay down my right eye does close which it did not do for quite awhile. The only movement I have on my right temple is a slight lift of the inner tip of the eyebrow. When I try to wrinkle my brow it goes slightly past center but it curves downward. The corner of my mouth was much further down than now. Originally there was no movement at all. I am now able to turn the corner up and the area of movement still seems to be increasing.
A: Thanks for sending your pictures. What they indicate to me is the following:
The frontal branch of the facial nerve is gone which is why the eyebrow does not lift up. As long as the eyebrow has not drifted lower than the opposite normal left side, I would not do any procedure for it. (i.e., browlift)
It is good news that the upper eyelid does now nearly close. As long as it closes completely when you lay down, I would not place a gold weight in the upper eyelid which is the normal treatment for a partial or slow closing upper eyelid.
The lower eyelid, as previously mentioned, needs a procedure which will help it considerably. It needs to be lifted and tightened up against the eyeball. To achieve this more is need to be done than just a traditional lateral canthoplasty. (tightening the lateral canthal tendon at the corner of the eye. That procedure needs to be combined with a fascial sling (harvested from the temporalis fascia) that would be placed from one corner of the eye to the other, much like a clothesline. Together this is the most effective method for lower eyelid tightening and resuspension.
The right face and lower corner of the mouth appears to be in some state of gradual improvement although it is probably not realistic to think that completely normal mouth movement will ever occur. However,, as long as it is improving, I may defer any type of static corner of mouth resuspension until later although that is still up for further evaluation.
The entire right facial droop may be treated with a complete facial resuspension (facelift) on the affected side. That is certainly reasonable to do at anytime. This may be combined with a corner of the mouth lift, both of which will not negatively impact any ongoing facial nerve recovery.
The right temporal area is sunken in due to the effect of the combined craniotomy and radiation, which has caused the temporalis muscle to shrink or atrophy. This is a very common effect from this exact neurosurgical procedure. The temporal area could be built back up using a variety of techniques which would depend on the dimensions of the volume lost. I can not tell exactly from the pictures to give you a better idea on how that would be done yet.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I have some questions about the lateral commissuroplasty procedure. Could a corner lip lift be done in a manner which would not shorten the upper lip or “plumpen” the lips (these things are mentioned as coming along with a corner lip lift but I would rather not have them as I think they would be top feminine). I also realized you do brow shaping. My eyebrows arch out on the ends and I would rather them lay straight across (or at least close to that). Could this be done? Finally, could all these procedures be done in one session?
A: You appear to have some misconceptions about the corner of the mouth lift. It does not affect lip size or shorten lip length. Whether a corner of the mouth procedure is done to lift up the corner or to widen horizontal lip length, there is no change in the rest of the lip shape or size.
From a brow bone shape standpoint, it sounds by your description that you have too much lateral brow bone protrusion. That can easily be reduced through an upper eyelid incision by burring down the side of the brow area that does not have the frontal sinus lying underneath it.
Both the corner of the mouth and brow bone procedures could be done at the same time. Combined it would be a two hour procedure done on an outpatient basis.
Dr. Barry Eppley
Indianapolis, Indiana
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
Indianapolis, Indiana
Q: Dr. Eppley, I am a 48 yr old female. Over the past few years, the corners of my mouth have started drooping, to the extent that I am often asked if something is wrong (it appears that I am frowning all the time). I don’t want major surgery, and in researching options for my issue, the corner of the mouth lift seems to be a possibility. One additional note; the droopiness is more pronounced on the right side. I have attached some photos for your assessment.
A: Downturning of the corners of the mouth is a common aging issue. The lip line is the union of the upper and lower lip at rest when one is not smiling or has any oral animation or movement. It is like a level and one should be able to draw a straight line between the two end points to create a straight lip line. The corner positions of the lips or the commissures have a great influence on the appearance of the lip line. You don’t want them upturned (Joker look) or downturned (frowning or sad) as it gives one a static expression that is not favorable. Corner of the mouth lifts change the location of the commissures through a very small amount of skin resection and lip vermilion repositioning. It is a relatively simple procedure that can have a dramatic effect. It can be done under local anesthesia as an office procedure. It does the one thing that many people think a facelift does but does not. A facelift can not change the corner of the mouth because its pull is too distant. Changing the corner of the mouth must be done by direct excision.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am interested in the corner of the mouth surgery to lift up my downturned and sad looking mouth. What are the risks, recovery time, and success rate of this procedure? Is the procedure an office visit? What number of follow up procedures are required?
A: The corner of the mouth (COM) lift is an office procedure done under local anesthesia. Dissolveable sutures are used so no return visit is necessary for out of town patients. I would say there is really any true recovery, just some redness in the corners of the mouth for several weeks and time to let the scars fade. There are no dietary or oral hygiene restrictions afterward. It is always a successful procedure as the corners are always leveled out rather than downturned. The key is not to overdo it so the corners are turned up or give someone a ‘joker’s smile’. There will be a very fine line scar that emanates out from the corner of the mouth about 5 to 7mms, but it is very small. Sometimes there may be a need or it is of benefit to do some other minor procedures around the corners of the mouth. (e.g., fillers to marionette lines) This is why it is a good idea for me to see a picture of your mouth in a non-smiling position to determine if this is the corner of the mouth lift procedure for you.
Dr. Barry Eppley
Indianapolis, Indiana
Q: As a 59 year-old female, I am interested in the corner of the mouth lift. I had a facelift four years ago which did help the corners of my mouth to some degree but they need more attention. They are still downturned to some degree. Any info or photos would be appreciated.
A: Contrary to popular perception, a facelift has little effect on the corners of the mouth. In general, a facelift will not turn up corners of the mouth that are drooping down. It will have a very mild effect but nothing significant. This runs contrary to the fear that the corners of the mouth can be pulled way to the side and distorted if a facelift is ‘overdone’. Such is not the case. The mouth is a long way from the point of pull which is by the ears in a facelift. By the time the pull force reaches the mouth, it has little power left to much of anything. The downturned corner of the mouth must be attacked directly with a procedure right at where the problem is located.
The corner of the mouth lift is a simple office procedure done under local anesthesia. It involves the removal of a small triangle of skinjust above the downturned corner. In its replacement, the mouth corner is moved upward. It can be done conservatively or more aggressive depending upon the degree of downturning of the corners of the mouth. There is virtually no recovery other than some persistent redness at the corner of the mouth for a few weeks. This simple mouth procedure is powerfully effective.
Dr. Barry Eppley
Indianapolis Indiana
Q: I have drooling from the corners of my mouth and its embarrassing. I am 73 years old and have not had a stroke and I am still working everyday. What can be done for this corner of the mouth drooling problem. It was also occasionally get red and sore and painful. When this happens, it takes a fair while until it finally gets better. I have tried all sorts of antibiotic creams and salves but nothing seems to be that effective. I have read about a procedure called the corner of the mouth lift that removes the overhanging skin. Do you think this will help?
A: Downturning of the corners of the mouth, combined with aging which creates a skin overhang, creates a gutter effect at the corner of the mouth. This is the perfect setup for a runway for saliva. This problem can be further magnified with one has overclosure of their lower jaw due to a loss of teeth or ill-fitting dentures. This overclosure causes a lower lip inversion which makes the drool problem at the corner of the mouth worse. Localized infection at the mouth corners can happen due to the chronic wetness of skin that is not normally so like the lining inside the mouth. This is known as angular cheilitis. Topical steroids and antifungals can help but a change of the anatomy is more effective.
The corner of the mouth lift can be really helpful for this problem as it removes the skin overhang and lifts the mouth corner. This eliminates much of the spillway problem. There is a trade-off of a small scar that tails away from the mouth corner but this is not usually a significant cosmetic concern.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hi Ii am 22 years old and would like to undergo a rhinoplasty procedure with you since I have read some very good things about you. I am aware about the rhinoplasty surgery and I don’t need further information on that procedure. But I was wondering if you can fix another facial problem. The distance between the mouth and the nose is very good. But when I close my mouth its like fat or muscles pile up and that makes the area between my mouth and the nose look big, even though it is not. In addition, the corners of the mouth droop down and give me a sad face appearance. Is there any surgical techniques to fix these problems?
A: The upper lip fullness to which you refer seems like a natural phenomenon . If you open your mouth, the upper lip thins as the nose moves upward and the upper lip stretches downward over the teeth. When you close your mouth, the ‘accordion’ shortens and the upper lip gets fuller again. This seems to be a normal tissue reaction and there is certainly nothing that can be done to surgically change the thickness of the upper lip at rest.
The downturning of the corners of the mouth, however, is a different issue. That can be changed through a simple procedure known as a corner of the mouth lift. A small triangle of skin is removed just above the downturned corner to bring it back to a more horizontal lip level.
Dr. Barry Eppley
Indianapolis Indiana
Q: I always had a very thin upper lip with down turned corners. I have had dental implants (7) and a permanent bridge for my upper teeth recently. I noticed that my top teeth no longer show when my mouth is at rest and that my bottom teeth which hardly showed before are now quite visible when my mouth is relaxed and when I am talking. My dentist said this was due to aging (I am going on 51) I read an article by you on Lip Augmentation and was curious if I should be looking into a face lift or a lip procedure? I had my lips enchanced once (not sure what product was used, I am allergic to collagen) and the results were overly swollen and then within two weeks all was gone. What do you recommend?
A: The thin upper lip can be due to aging, a naturally smaller amount of vermilion tissue (pink part of the lip) or a combination of both. When you combine a naturally thin upper lip with aging and the need for dental implants (maxillary bone atrophy), you have the perfect setup for a very thin upper lip problem. When the vermilion is this thin, no injectable filler will provide a good outcome. While I think it is good that you tried the simple approach of a filler, one could have predicted that the results would not be good. But you have now at least proven that a surgical treatment is needed.
The way to get a fuller upper lip is to create more vermilion. This can be done very successfully through a lip advancement procedure. By removing a strip of skin above the lip and moving the existing vermilion upward, the upper lip will instantly and permanently become fuller. When this is combined with a corner of the mouth lift (through the removal of small triangles of skin above the downturned corners), you will have an instant change in the entire look of your upper lip and mouth area.
Dr. Barry Eppley
Indianapolis, Indiana
Q: How do you do mouth widening? I have a relative that is scheduled for that procedure and we are hesitant to do it. We have never heard of such a thing. How safe is the procedure? Thank you for any information that you can share with me.
A: The concept of making one’s mouth wider is possible but very rarely done. I can only assume that your relative has a small horizontal width to their mouth (small mouth) and wants it to be extended further horizontally.
Such an operation is possible by using the principles of commissure creation or modification. Known in plastic surgery as a commussuroplasty, the corners of the mouth can be either shortened (closed down) or opened up. (made wider). To make the mouth wider, a modified isoceles triangle of skin is removed out to the distance you want and the inner lining of the lip (mucosa/vermilion) is advanced out and sewn to it. (a Y-V advancement) This relatively simple procedure will make the mouth wider but does so by leaving small scars at the corners of the mouth at the junction of the skin and the lip tissue. If not overdone too much, it can definitely make a difference and look fairlu natural. Such a technique is used in the more commonly done corner of the mouth lift, where downturned corners are turned up and made more horizontal to get rid of frowning or a downturned smile.
Conversely, the reverse can be done to make a wide mouth small. (a V-Y advancement) This leaves a more noticeable scar in its wake as the lip lining is moved further inward.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I have been suffering from angular cheilitis subsequently leading to cutaneous candidiasis and sometimes even a secondary bacterial infection for the past 18 months. If my face starts to sweat I immediately dry off my face but am mortified when I awake to realize saliva has pooled in the little cracks in the corner of my mouth. Despite my best efforts, I cannot always keep this area dry.
My dentist told me that it was due to a parafunctional habit and anatomical variation. So I changed the one thing I could control and stopped licking my lips. However, since then my best efforts barely keep this at bay and last week I had a tiny pimple in that area, the skin broke open, and you know the rest, the lovely normal flora became and opportunistic pathogen eating my face away, looking unsightly, and cracking my skin open if I accidentally open my mouth too far.
People think I am crazy for wanting surgery and I fear the opinion of female family members due to the new age stigma of getting plastic surgery too young. This is not for vanity unless you count wanting to be kissed vain, and when I have this crap on my face even I do not want to kiss me! Or look at me for that matter, not to mention how painful and itchy this can be and how long it takes to heal!
I have read that there is a possible surgical treatment for angular cheilitis. What is it and do you think it will be helpful for me. I am just looking for a permanent solution to this nasty mouth problem.
A: Angular cheilitis, also called perleche, is an inflammatory mucositis at the corner of the mouth and usually affects both sides. It presents as deep cracks or splits which may bleed when the mouth is opened widely. Why it occurs is not known precisely. Chronic wetness at the corners is the incipient event and that is most understandable in the elderly edentulous population who experience a loss of vertical dimension due to loss of teeth, thus allowing for over-closure of the mouth. This creates a spillway for saliva and chromic wetness in the mouth corners. Yet I have seen it just as often in younger patient who have a normal angulation of the corner of the mouth.
For those patients that have exhausted all medical treatments for angular cheilitis, surgical treatment is possible. When the corners of the mouth are sufficiently downturned, I have found a corner of the mouth lift to be helpful to change angulation and eliminate that spillway effect. In younger patients with a normal horizontal angulation, a resection of the mouth corner mucosa with mucosal advancement can be done. Sometimes this can include skin as well. The theory here is that the tissues are chronically infected and it is removed. I have seen improvements of the condition with both approaches.
Dr. Barry Eppley
Indianapolis, Indiana