How can I get the corners of my mouth to turn "up" again -- instead this "frown" I have, when I'm not smiling...
How to Get Up-turned Lips?
Doctor Answers 8
Corner Lift for the Corners of the mouth
In certain instances, patients may develop sharp downward turning of the corners of the mouth making them look sad or angry.
There is a procedure called a "corner lift" which lifts the outer corners of the mouth and pulls them out of the deep groove which blends with the marionette lines.
There are a few variations on the incisions ranging from triangular excisions to heart shaped excions of skin with repositioning of the corner (commissures) of the mouth.
Typical removable sutures are placed and removed within a week.
This is in contrast to the lip lift procedure which can be performed using several different options with scars residing on the white roll (lipstick liner) or immediately beneath the nose.
It is not uncommon to perform these procedures in tandem with a facial rejuvenative procedure.
Filler or Plastic Surgery
For patients under 60, or whose skin is moderately firm, placement of a hyaluronic filler can correct this problem quite readily. My preference for this area is Restylane since I feel it gives better support. However, Juvederm can be used, especially if there are other areas to be filled that are more adaptable to this filler.
The filler is injected into the small triangle that seems to form with the down-turned smile. This is done with a fanning technique approaching at different angles. Then the corner of the lip is injected straight on and a nice lift results.
One caveat: this procedure often requires more filler than you might expect. It is better to have great results on both sides than either great result on one side and mediocre results on the other, or mediocre results on both sides. So, it might be better to save your money so both sides can be corrected optimally.
If you are over 60 or have saggy skin, a plastic surgeon can perform a smile lift in which the above mentioned triangle is excised and the corner lifted up.
Downturned oral commissure (depressor anguli oris muscle)
Reference: Petrus GM, Lewis D, Maas CS. Anatomic considerations for treatment with botulinum toxin. Facial Plast Surg Clin N Am. 2007; 15: 1-9
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How To Get The Ends of My Smile To Turn Up
There are two fairly easy ways to accomplish this. The first is with the use of Botox. There is a muscle called depressor anguli oris which runs from the corner of the mouth to the angle of the chin. If you place a small amount equally to both sides where the muscle meets the jaw, you will block that muscle and naturally lift the smile up. If this technique still does not pull your smile up, you can add a filler such as Juvederm or Radiesse, or Restylane in a crosswise manner to the angle of the smile to physically perk it up by bolstering it up. Botox to this area lasts approximately 3-4 months and each filler varies on duration.
Turning Up The Corners of Your Mouth Techniques
Depending on the individual, there are different approaches to this problem.
For most people, conservative management is effective, simple, and safe. There are two approaches that I usually use together. The first is to weaken the muscle called the depressor anguli oris. This muscle pulls down on the corners of your mouth. This is accomplished with a small amount of Botox. Putting Botox here is not to be confused with placing it in the lips where side effects are common. Side effects of treating depressor anguli oris are rare (I have never seen one).
The second method is to also use fillers such as Juvederm and Restylane. The Botox blocks the muslces from pulling the corners down, and the filler pushes the corners up (as well as fill the creases). Together, these treatments satisfy the vast majority of paitents.
Surgery is only for the severe case that fails to respond to other techniques. It is difficult to describe here, but there are ways to move the corners of the mouth. There are some incisions that hide well in older skin, but this is not for the younger patient.
Injectables or Surgery
What you describe is a very common concern, that is, the downturned corners of the mouth. This can be addressed by:
1. Injectables like Restylane or Juvederm. When these are injected into the corners of the mouth, it can serve as a platform to lift up the corners.
2. Surgery. The most direct approach is an anguloplasty (AKA a "corner lift"). This procedure can be done under local anesthesia where a triangle or heart shaped portion of skin is removed from each corner of the mouth. The corner is then lifted and the incision is closed with sutures, which stay in for about a week. With a meticulous wound closure, the scar is often imperceptible (especially if you wear lipstick!). This often addresses the downturned corners better than other procedures (like a facelift).
Facelift versus fillers
Downward desend of the lip corners is a common complaint as people age. As many of my colleagues have posted, the best strategies include either a filler such as restylene or juvederm or facelift procedure. The latter will of course correct for other signs of facial ageing too.
Upturn corner of the mouth
This is a common complaint for many of my patients. For the younger patient, it is easy to correct with facial fillers like Juvederm or restylane. For older patients, there may also be laxity of the soft tissues that would best be served by a Facelift to get the lip to turn up.