Your Questions

Q: Dr. Eppley, I notice you also do a surgery that can increase the width of your mouth. (mouth widening surgery) Can this be combined with a corner lip lift? Also does the procedure that increases the size of the mouth help the smile out? I notice when I smile I only have about 4 teeth showing on each side not because of the way my teeth are but because of how narrow my smile is. It just doesn’t stretch nearly as far as I would want it to. Would a wide mouth surgery give me more of a cheshire cat grin where I would be able to expose more teeth on the sides?

A: A mouth widening procedure can be combined with a corner of the mouth lift. It is just how the angle of the mouth widening is positioned to create that effect. A mouth widening procedure has a static effect, not a dynamic one. It is the pull of the zygomaticus and upper lip muscles that drives the corner of the mouth and the upper lip upward and outward to expose the teeth. It is not how wide the distance between the mouth corners are that has the biggest effect. Thus, I would not expect much improvement in tooth show just with a mouth widening procedure. But it certainly will not hurt and may have some small improvement in tooth show.

Dr. Barry Eppley

Indianapolis, Indiana

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

Indianapolis, Indiana

Q: Dr. Eppley, is there a mouth widening surgery? can a mouth actually be enlarged? My mouth is so small dentists literally have difficulty working inside. One told me it was the smallest mouth he’s ever encountered  (I’m not making this up). A 1/4 inch more would make me and my dentist infinitely grateful. But is that possible?

A: Yes a mouth can really be enlarged or made wider (longer) from a horizontal standpoint. Known as a lateral commisuroplasty, the corners of the mouth are opened up and the horizontal width (length) of the corners are expanded. This is done by making  a 1/4 inch (6mms) incision in the skin from the vermilion-cutaneous junction horizontally outward. Then the vermilion lining (pink part of the lip) is advanced from the inside out to make a new lining and corner point. While an incision is necessary, all scars line remain along the vermilion-cutaneous junction (skin-lining edge) and not beyond the corners of the mouth. When done on both sides this amounts to a 1/2 inch mouth widening. When you factor in scar contracture of about 25% to 33%, that still leaves one with a 1/4 inch or more increased mouth width.This is a very simple procedure that can be done under local anesthesia.

Dr. Barry Eppley

Indianapolis, Indiana