Your Questions

Q: Dr. Eppley, I am working on a story and wanted to get a quote from you in regards to mouth lift surgery. What are your thoughts on people who are having it at a young age – are there pros and cons? How serious is the operation? What is the  average age for this procedure? Does it make a difference on Asian patients?

A: Corner of the mouth lift surgery has been around for a very long time. It was introduced over fifty years ago, long before facelift surgery was widely done. It was developed to treat the downturned corners of the mouth that develop from aging as the facial tissues sag. This facial droop pushes down on the mouth corners changing a horizontal smile line to an inverted smile line (at rest) in some people. The corner of the mouth lift was done to directly remove the overhanging skin and lift up the commissures. (corners of the mouth) It is a very effective small procedure that has not really changed over the years. Despite its history, it is not well known and many think it is a new surgery.

A corner of the mouth lift is a very simple procedure done in the office under local anesthesia. There is virtually no recovery other than having a few small sutures for a week. While it is incredibly simple to do from a plastic surgery standpoint, it is a very technique sensitive and delicate procedure in which the design of the cutout must be very carefully done to achieve a good result and not have any adverse scarring.

As you could surmise by its history, the corner of the mouth lift is traditionally done for patients who have general facial aging concerns. (usually greater than 45 to 50 years of age) But I have done the procedure on much younger patients (as young as age 16) who naturally have downturned corners of the mouth or corner of the mouth asymmetry. (one corner turned down, the other one normal)

As you have mentioned Asian patients, you may be referring to the recent internet story on the ‘Smile Lipt’ procedure out of Asia. This is just the traditional corner of the mouth lift done to give patients a permanent smile or mouth curls, often it appears on younger patients. By American standards, the Asian mouth curl result would be considered unnatural and exactly the ‘complication‘ from a corner of the mouth lift that we would want to avoid. But this is just the fashion and beauty differences between countries with very different cultures. You may read more about this in my recent blog story entitled ‘The Global Differences in Corner of the Mouth Lifts’.

Dr. Barry Eppley

Q: Dr. Eppley, you are the first surgeon that has listed this on their site. I have been looking for a solution for my downturned mouth for years now and finally I have found it! My mouth has been troubling me for several years now and I keep having to sleep extra and drink extra coffee all the time so I dont feel tired so that my lips dont droop and mine have quite a severe droop. I just have a question and that is how long does the corner of mouth lift last for(how many years) before it starts to downturn again?

A: The downturning of the corner of the mouth is a result of either a natural shape of the mouth corners or skin pushing down on the corners of the mouth. This may be from a normal anatomic shape to one’s mouth or from aging as the descent of midfacial tissues pushes down around the mouth. Depending upon one’s age, it may be one or the other or often a combination of both factors. The corner of the mouth lift is the single most effective method for changing the mouth corners that I know. While there are some non-surgical options as well (Botox, injectabale fillers), its excision of skin makes it relatively long-lasting. The question of how long-lasting is an interesting one and that would depend on numnerous factors such as one’s age, the cause of the downturning and how the rest of the face is aging. For some patients it is a permanent change, for others its effects may last years but not necessarily permanent. I would need to see some pictures of your mouth/face to answer that question better for you.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have angular cheilitis and have had it for over 8 years since I was 14. I have tried numerous steroid and anti-fungal creams however it does not go away permanently. I was made aware some surgery can be done on the lips, to solve this problem. If there was something to be done, I’d like to know what it might be?

A: While topical medication is the primary treatment for angular cheilitis, some patients have an anatomic arrangement at the corners of their mouth that predisposes them to chronic salivary wetness. If the corners of the mouth are turned down significantly, there is a natural spillway for salivary spill or to allow chronic wetness to occur at the mucosa of the mouth corners. In these cases, it may be beneficial to consider a corner of the mouth lift to relieve this spillway effect.  The lift removes the overhanging tissues and eliminates a downslanting mouth corner. In other cases without a significant corner downturn, the chronically inflamed or irritated mucosa just inside the mouth corners may be simply excised. This removes the chronically infect mucosa and brings in new healthy mucosa that is not inoculated.

Dr. Barry Eppley

Indianaopolis, Indiana

Q: Dr. Eppley, I am only 56 years old but have a chronic infection of the skin below the corners of my mouth. I’ve been running for 36 years, so maybe that contributed to the sagging.  More likely it’s a combination of things including the effects of menopause. The skin below the edges of my mouth is now chronically inflamed.  Would surgery to correct this be considered medically necessary?

A: Sagging of the corners of the mouth can be a cause of angular cheilitis. Acting as a spillway for saliva, this can make the skin on the corners of the mouth chronically exposed to moisture resulting in a yeast-type skin infection. The first step would be to use a topical medication to treat the infection and then consider a corner of the mouth lift to change the skin’s exposure to salivation.

The sagging of the corners of the mouth is a simple function of aging and has nothing to do with running and menopause. It is the slow and inevitable of the lateral facial tissues falling forward against the fixed perioral tissues. Some people’s natural anatomy makes them more predisposed to deepening nasolabial folds and a skin overhang on the mouth corners driving them downward.

Dr. Barry Eppley
Indianapolis, Indiana

Q: Dr. Eppley, I had a facelift about six weeks ago. This was a very traumatic experience for me. While my jowls and neck got better, my nasal folds and turned down corners of the mouth did not. They initially looked good while I was still swollen but that has now all gone away. This is very disappointing since this was one of the main reasons I had the operation. I feel like a wasted my money as my jowls and neck were not that bad.

A: This is a common misconception and occurs either as a result of inadequate education during the consultation or a failure to understand what a facelift does best on your part. Because the tissue pull of a facelift occurs from around the ears, it has the least effect on anything far away. The mouth area is the furtherest point from the ears on the face, thus deep nasolabial folds or a downturned corner of the mouth will ultimately remain unchanged. It is just biomechanically impossible to substantially change the center of the face from back in the hairline. This is an issue that has frustrated facelift surgeons for years and many techniques have been tried, few with much success. This is why adjunctive techniques are often done with facelift that address the mouth area directly, like fat injections and a corner of the mouth lift. These can be at the time of a facelift or afterwards as may be desired in your case.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have deep nasolabial folds and a mouth whose corners turn down. I have read about a way to improve them by using your own tissue through grafting. I had a facelift already which got rid of my jowls and helped my neck but didn’t do a thing for the area around my mouth. I don’t want to treat them with injectable fillers because that will only be temporary. Are you familiar with this tissue grafting technique?

A: What you are talking about is an old plastic surgery technique, dermal-fat grafts, that has been applied to a cosmetic problem. A dermal-fat graft is a piece or strip of skin that has a thin layer of fat on its underside. The overlying epithelium or skin layer is removed, leaving just the dermal skin layer with the attached fat. Provided that the graft size is not too big, it survives quite well as the blood vessels of the recipient site attach quickly to the vessel ends in the dermis. This allows a quick return of blood flow to the fat thus enabling it to survive.

For use in the face for nasolabial folds,  it must be taken from the lower buttock crease or any other large scar site and must be at least 6 to 7 cms in length for each nasolabial fold. From inside the nose, a tunnel is made under the nasolabial fold curving down to the corner of the mouth. The dermal-fat graft (dermis side up) is then placed through tunnel and fixed to the corner of the mouth through a small incision from inside the corner. It is then lifted and tightened from inside the nose and the excess graft trimmed and closed. The graft simultaneously augments the nasolabial fold and lifts the corner of the mouth. I have done this procedure numerous times and it does have its merits. But the issue is that it requires a harvest site and the buttock crease is almost always the best choice because of the thicker dermis. The discarded skin from a pretrichial browlift can be used as well. There are also other simpler ways to achieve both of these facial objectives. Fat graft injections combined with a corner of the mouth lift is another approach. But for the right patient who does not mind a buttock scar, the dermal-fat graft approach can be used.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  I am interested in a corner of the mouth lift. I have checked in my area but have been unable to find anyone as of yet.  How would it work if I was to choose to see you? How many trips would I need to make? Have you done many of the corner mouth lift procedures?  I am 48 and do not feel I need, nor do I want at this point, a face lift as it is really only the beginning of slight mouth droop/marionette lines that really bothers me.

A: In answer to your questions, We have many patients how come from afar so we are very familiar with working with out-of-town patients. Ultimately, a corner of the mouth lift is done as an isolated procedure in the office done under local anesthesia. One only needs to come once, for the procedure only. An initial consult can be done by phone or Skype with photos of the mouth area sent in advance. Everything that needs to be discussed and determined can be done from afar. Once the procedure is done, there are no sutures to remove as they are just tiny dissolveable ones on the skin. There are no restrictions after surgery. Any follow-ups can be done like the initial consultation by phone or Skype with photos. A corner of the mouth lift is really a simpl;e proedure with the minor trade-off of a small scar. I have performed many of them either as a sstand alone procedure or often in conjunction with facelift surgery.

Dr. Barry Eppley

Indianapolis Indiana

Q: I am interested in corner-of-the-mouth lift surgery? I tried injections to turn up the corners of the mouth but that didn’t work. Then I went to a plastic surgeon who told me a facelift would make the corner of my mouth look better…and it didn’t! Since injectable fillers and a facelift didn’t work, I read about this procedure on the corner of the mouth. That seems like it would work. Can you tell me about the scars? Thanks!

A: For the downturned corner of the mouth (frowning or upside down U-shaped smile line), neither injectable fillers or a facelift will be successful. Either one may help a little but not generally for mouth corners that are more than just a little down.

The corner of the mouth lift is a simple but very effective procedure for leveling out the smile line. While it is a very small procedure, it can easily be overdone if the plastic surgeon is not careful and go the other way, up too high. (i.e., joker’s smile) By removing a small triangle or heart-shaped piece of skin just above the corners of the mouth, the tail of the smile line is brought. This does result in a small scar, about 7mms or so, off of the corner of the mouth that points up in the direction of the ear. But it is a very small scar that fades quite quickly.

A corner of the mouth lift can be done at the same time as a facelift or can be done as a stand alone procedure. When done by itself, it can be done under local anesthesia in the office. There is no recovery or any significant swelling or bruising. Tiny sutures are removed in a week or for out-of-town patients only small dissolveable sutures are used.

The corner of the mouth lift is a ‘cute’ little procedure that really can make quite a difference in one’s smile.

Dr. Barry Eppley