Your Questions

Q: Dr. Eppley,  I am very interested in having a surgical procedure to make the width of my lips longer. (mouth widening procedure) I am fully aware of the pros and cons of this procedure but the pros do weigh out the cons. I’m just enquiring more information as to the procedure such as how long I would be out of work for and is this a procedure that I would need to have done frequently?

A: The mouth procedure to which you refer is technically known as a lateral commissuroplasty (mouth widening procedure) where the corners of the mouth are opened up at the skin level and the vermilion/mucosa lining is brought out to make the horizontal length of the mouth from corner to corner longer. (wider) When you speak to ‘do I need to have it done frequently’ you are likely referring to the potential for scar contracture which may require secondary release. While this is a risk, it is not an expected outcome and hopefully would not occur. Thus a successful mouth widening procedure would be a one time procedure with permanent effects. As a general rule the horizontal width of the mouth can be increased about 5mms per side for a total of a 1 cm mouth width increase.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have very small mouth and I hate it! Iwas looking up online about widing my mouth and your name comes up the most! I saw this type of surgery (lateral commissuroplasty) and I am curious as to how it is done and the results. Thank you!

A: While a lateral commssiuroplasty will widen the location of the corners of the mouth, there will be some fine line scars at the junction of the vermilion-cutaneous junction. The procedure is, in essence, a Y-V vermilion advancement. The horizontal limb of the Y is how far the new corner will be located to the side. The line is then cut (opened) and the vermilion of the corner of the mouth is then advanced outward to the end of the line that was opened and then sutured there. This is how the mouth gets wider. Is it a good cosmetic procedure? I think it depends on how small a mouth one has. I would have to see pictures of your mouth to see if it would be beneficial for your aesthetic goals. Scars are always a trade-off for any lip vermilion procedure so you have to have a significant enough aesthetic problem to make that exchange.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have several questions regarding the mouth widening procedure. How is the procedure done and much can the procedure help? How natural are the results?  

A: In answer to your questions about mouth widening, also known as a lateral commissuroplasty:

1) The corners of the mouth can be moved outward  anywhere from 5 to 10mms per side. As a general rule, the corners of one’s mouth should not be any wider than that of a vertical line dropped down from the pupil of the eye. This is not a hard and fast rule but an historic aesthetic anthropometric one. It can be surprising how much difference a few millimeters can make. The procedure is done by a skin excisional method known as a Y-V advancement where triangles of skin are removed from a line drawn out from the corner of the mouth to the desired distance. The corners of the mouth are then brought out to that point and closed.

2) The corners of the mouth, as long as they are not extended too far, can look natural. There are fine line scars at the junction of the red of the lip and the skin at the corners of the mouth as a trade-off. Generally these scars are fairly discrete and not a distraction to the result.

Dr. Barry Eppley

Indianapolis, Indiana

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
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