Cost? Procedure details? (photos)

Hi, I'd like to know if you adjust the muscles at the corners of mouth to stop them from pulling downward and to prolong results? I'm concerned about that rat mouth look, scared of it actually. My nose is turned up so hope scarring will fade well. Maybe I need a mid facelift? For the lip work what is your fee given my needs? Thankyou very much.

Doctor Answers 10


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I always think it best to start with the least invasive procedure and see if you like the results so I would suggest that you schedule a consultation with a board certified plastic surgeon to discuss some Botox to lift the outer corners of the mouth. 


Kouros Azar

Thousand Oaks Plastic Surgeon
4.9 out of 5 stars 38 reviews

Treating jowls and a downturned corner of the mouth?

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It seems like you are going to get a variety of opinions from different plastic surgeons.  From your photograph it appears to me that you do have jowls and a vertically long upper lip with loss of volume around your chin.  In my Beverly Hills office I would be discussing the option of a facelift with autologous fat grafts to strengthen your jaw line and the angle of your jaw.  The corners of your mouth can be turned up to some degree with a facelift but damage to the muscles of expression needs to be avoided.  A much simpler approach and perhaps the best thing for you to start with would be an injection of Botox or Xeomin which is as effective as surgery in turning up the corners of your mouth.  I personally am against lip reductions due to the permanent scarring that I would suspect would always need to be covered with makeup.  Do your research until you find a board-certified plastic surgeon in whom you have confidence.  Regards

Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
ABC-TV Extreme Makeover Surgeon
Beverly Hills, California

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 32 reviews

Face Procedure

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Thank you for your question. You have a couple options. Two units of Botox into the lower jaw line will result in elevation of the corners of your mouth. This is non surgical. It takes a minute to do. Another option is an endoscopic mid face lift which I helped to pioneer. The main incision is underneath the lower eyelid. The third option is excision of upper lip skin which will leave you with a permanent visible scar. For more information please see the enclosed video and I hope you find this information helpful. 

Joshua Halpern, MD, PA
Tampa Plastic Surgeon
4.8 out of 5 stars 65 reviews

Options for downturned lips

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You have a few options depending on what your goals are.  If you want temporary results with a minimally invasive approach, Botox (or similar) medications can help even out the corners or turn them up a bit.  You could have a face lift as you have some jowling, which will also help with the angle at the corner of the mouth.  Costs vary depending on what is done - there are a number of options - as well as what region of the country you are in.  It is a few hundred dollars for Botox in most areas, and between 5-10k for surgery.

Thomas A. Pane, MD
Palm Beach Plastic Surgeon
4.2 out of 5 stars 47 reviews

Improving an aging lip

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Thank you for asking about your facial procedures.

  • Your upper lip has as you know lengthened - so you definitely need a lip lift.
  • This is an office procedure, done under magnification that shortens the upper lip.
  • The fee will be between $2000 and $2500, depending on the area of the country it is done.
  • Botox at the corners of the lower lip or into the DAO muscle along the jaw will help the corners to turn up.
  • You can consider other treatments (skin care, fillers, Botox, peels) and face lifting surgery as well - depending on what you want and what your plastic surgeon recommends. 

Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Corners of mouth turn down

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Dear Melodysue:

Thanks for your questions. I can address most of them from the one picture we received--but, in the final analysis, an in-person exam would be necessary for a detailed recommendation (especially regarding a mid-face lift, because that part of your face is not visualized). I see that the upper lip is elongated, so a "lip lift" might help you, in addition to a SMAS-facelift to address the jawline, neck and cheek aging (and which often can "reset" the position of the corner of the mouth). I recommend  that you see a board-certified plastic surgeon in your area who has a lot of experience in facial rejuvenation to discuss your options and the costs in your area of the country (which can vary substantially).

James H. Scheu, MD, FACS
Saint Louis Plastic Surgeon
4.5 out of 5 stars 27 reviews


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Hello and thank you for your question. Based on your photograph, you may benefit from a mini facelift with a neck lift.  If good technique is used, this can be done with minimal scarring and can result in a natural look, not over-done look, with rejuvenation of your face.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results. The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 172 reviews

Cost for a facelift

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Cost factors vary significantly for a number of good reasons: Prices vary greatly because the surgery itself encompasses a wide range of techniques that can be performed to different extents. My recommendation is to first find the most qualified surgeons where you want the surgery performed that are board certified by the American Board of Plastic Surgery you trust, then compare prices between them. See the below link on suggestions on how to find the most qualified plastic surgeon for your procedure. General Factors that influence the price of plastic surgery include:

1. Location - Will it be performed in a hospital with an overnight stay, an independent out- patient facility or a doctor’s office? Geographical location also has a significant influence. RealSelf has average charges for most areas of the USA.

2. Type of Anesthesia - local, IV sedation or General Anesthesia? Will a board certified anesthesiologist, nurse anesthetist, or an RN be used?            3. Experience and training of your surgeon. The best and longest trained is most often a plastic surgeon board certified by the American Board of Plastic Surgery           4. Length and Complexity of Surgery - how difficult will your surgery be and how long it will take, etc. Will other complementary procedures also be also performed during the same surgery?

Hi, I'd like to know if you adjust the muscles at the corners of mouth to stop them from pulling downward and to prolong results

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 Hi, I have performed facelifts for over 30 years and have performed many minimally, invasive type facelifts.  From the photos you have "jowls" which create the "Marionette Lines" around the mouth that you have described.   Following the beauty principles outlined in my book on face and body beauty, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.

 "Jowls” are sagging facial tissues and an indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.

My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:

  • very small incisions and no incisions extend or are placed within the hair.
  • minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
  • can be performed in 90 minutes or less, with or without general anesthesia
  • no incisions within the hair = no hair loss
  • excess fat can be removed
  • excess skin removed
  • cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
  • most patients fly back home to parts all over the world in as little as 3 days post-op

I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Fat Grafting Can Help the Area Around the Mouth

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You have significant relaxation of the tissues around your mouth, and a lot of vertical lines and wrinkling in the lip area as well. Minimally invasive procedures such as fat transfer and skin resurfacing will help some, but a facial rejuvenation procedure that lifts the jowls and midface area is going to make the biggest difference. I routinely add perioral fat grafting to almost every facelift procedure to address the volume loss around the mouth that occurs with age. It is very important to look at before-and-after pictures of patients with similar aging changes to get a realistic idea of what you can expect and judge the surgeon’s technique and aesthetic. Mini face lifts in general will give a “mini" result around the mouth, because the deeper layers are simply pulled with sutures without actually being released and repositioned.  Cost varies widely.

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.