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What is the Best Facial Procedure to Address the Drooping Corners of the Mouth? (photo)

It looks like I am sad and frowning due to my mouth corners falling down. I have tried injectables and fat transfer with little success. Would a mid facelift or cheek lift address this?

Doctor Answers 40

Drooping Corners of Mouth and Facelift

     The drooping corners of the mouth, the jowls, and the marionette lines can all be addressed with SMAS facelift.

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Addressing the nasolabial fold with surgical and non-surgical procedures

As a specialist in facial aging, people are constantly coming to me to address this exact issue. It’s a problem called deep nasolabial fold that is due to facial aging in the lower third of the face. As we get older, we lose volume in bone, muscle and fat as well as the thickness of the skin to the point skin is collapsing inward. In addition, we also have loosening of the tissue that was formally in a higher position called facial descent or facial sagging.

In your situation, we are dealing with a two-part problem. Since the aging process may affect everyone differently, it may start with volume loss and then sagging.

My general approach is first to understand what would make the patient happy. Will they be happy with some improvement of this deep nasolabial fold (also called the marionette line) or do they want a definitive maximum improvement?

If the fold is due to descent and volume loss, then we do a combination of a face lifting procedure and then a fat transfer, where we take fat from one area and place it under the skin to help plump it up. Alternatively, I can do a facelift first then allow the patient to heal. After some time, the patient and I decide together whether we want to add some volume filler such as Radiesse, or a combination of  Radiesse and a hyaluronic acid like Restylane. We do combination procedures because volume loss is a combination of many factors: loss of bone, muscle, fat and skin.  In cases when people have very light nasolabial folds, then we can sometimes get away with just a little bit of Restylane or doing a moderate amount of Radiesse under the skin.

Depending on what your skin elasticity is and the outcome of your physical examination, you can make a decision. If you want a maximum improvement, then you can be aggressive.  However, if you want to take little steps, then you may consider starting with fillers and non-surgical procedures. I suggest that you find a qualified and experienced surgeon and learn about your options.  I hope that was helpful, and thanks for your question.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.5 out of 5 stars 40 reviews

Perioral surgical rejuvenation.

The upper melolabial (nasolabial) fold, oral commisure (corner of the mouth) and lower melolabial fold are the most challenging areas to resuspend during facial rejuvenation surgery.  In general, a subperiosteal midface lift is the most powerful method to elevate the upper melolabial fold and oral commisure while a deep plane facelift will address the lower melolabial fold.

Mario. J. Imola, MD, DDS, FRCSC.



Mario J. Imola, DDS, MD
Denver Facial Plastic Surgeon
5.0 out of 5 stars 56 reviews

Minifacelift versus injectables for drooping at the corner of the mouth

Either a minifacelift or  injectables can help for drooping at the corner of the mouth.  You are an excellent candidate for a mnifacelift and this would be more cost effective in the long run, although small amount of filler may be necessary in addition to completely correct the corner of the mouth.

How to Turn a Frown Upside Down with Surgery

The best surgical procedure that specifically addresses the far lateral mouth area is a "direct corner-of-the-mouth lift". This involves the excision of a triangular segment of skin on the upper corner of each side of the mouth. The only down side of this procedure is that there will be a scar that extends out from the corners of the mouth for about a half an inch in most cases (although this should be a very thin scar, and in line with normal mouth creases found in the area). However, this is a very effective procedure and is relatively minor and inexpensive compared to the next best surgery: The facelift.

A well-performed facelift should also lift this fold that results from the jowl and the relative depression/crease that forms in front of the jowl that creates the illusion that the mouth is frowning more. The facelift will make a mouth appear as if it is smiling more since it will smooth out and decrease the relative depth of this pre-jowl/pre-cheek area. If the "after" photos of facelift patients appear to be more pleasant or smiling more, then that is the most likely reason why it appears this way (the surgeon should not be ASKING for a smile in the "after" photos).

Richard Parfitt, MD
Madison Facial Plastic Surgeon
4.5 out of 5 stars 21 reviews

How to fix a frowning appearance

From your photos it appears as though you you would benefit from a lower and mid-face or cheek lift.  This will help reposition the tissue that is falling over the corners of your mouth.  Fillers and fat injections will not be helpful with this. One additional thing you might try after the face lift is a bit of Botox in the depressor muscles of the mouth- this can have a nice subtle effect on reducing the downturning of the lateral mouth, but will not correct the problem on tis won't without the surgery.

Droopy corners of the mouth

The drooping corners of the mouth and jowling are best treated with a lower face/neck lift.  Further examples of this can be found on our web site.  Injectables and fat transfer will not lift the corners of the mouth.

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 60 reviews

Drooping corners of the mouth

Thanks for your question.

We perform facelift procedures frequently in our San Francisco area office.  Usually a combination of short scar mid-facelift and possible fat grafting would make the most substantial change.

Skin laxity and dropping of facial fat pads is likely contributing to the overall look and these issues can be well addressed with a facelift.

I hope this helps

Procedures for drooping near corner of mouth

Thanks for your question and photo. This is a difficult area for complete correction to be sure. I think that the best correction would be a combination of both a midface lift and facelift. You need vertical correction and the combination will work together to reinforce the correction. I do not think that simple quick lift types of procedures will help, or give you a balanced correction. Take your time in finding your surgeon.

Ronald Schuster, MD
Baltimore Plastic Surgeon
5.0 out of 5 stars 35 reviews

Droopy corners of the mouth

There are two general approaches to this area.  A facelift with focus on that area would be one way to deal with the face, jowls and corners of the mouth.

Another way is direct surgery on the corner of the mouth.  This may require a visit with a plastic surgeon comfortable with this technique.  If not properly planned, the scar in that area can be more visible. 

Best Wishes!!

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.