How to avoid the joker mouth? Is it random or can it be prevented?

Prevent over-pulling the underlying SMAS, avoid too much tension on the skin layer, delicate handling of facial soft tissue, respect for facial planes and nerves within the surgical plane, awareness of the vectors of pull on each side, use of surgical landmarks/markings on the face to ensure symmetry; these are some basic core knowledge of a competent facelift surgeon.

I'm familiar with the "joker face" result you describe. You can rest assured that modern approaches to facelift surgery are rather effective at avoiding this. In most cases, this look results from excessive pulling on the skin or the underlying muscles of the face. This causes the sides of the mouth to stretch to the point of looking unnatural or forced. The best way to avoid this is to choose a board-certified plastic surgeon with ample before-and-after photos to get a good sense of your potential results. Be sure to share your specific concerns with your surgeon for a better sense of how your particular procedure will avoid it. 

Dear SpringrollThank you for your question!  The JOKER look is caused by pulling- whether its the skin or the SMAS or both.The key is that the surgeon shape your face.With Warm RegardsTrevor M Born MD

Thank you for your question about facelift.The most important determining factor in avoiding the "joker mouth" after a facelift is the angle or vector which the plastic surgeon pulls or suspends the face.  Straight back can give the wind-swept look and straight up can give the suspended like a curtain look.  Pulling on the corners of the mouth gives the joker mouth.  It is important that the plastic surgeon be atune to the subtle details in order to give you a natural look.
To be sure, see two or more experienced,
board-certified Plastic Surgeons in your area for a complete evaluation to make
sure you are a good candidate and that it is safe for you to have surgery.
I hope this helps.

This should be avoidable by limiting the tightness of the suturing to achieve the lift and the preventing an overly upward vector of lift for any suturing which affects the corner of the mouth. With the deep plane lift there is excellent control of these variables and thes are some of the reasons I feel the deep plane lift achieves the best results. Best wishes, Dr. Donath

Hello!Although the type of face is important, a natural face lift result depends on the surgeon's skill, experience and technique. The "joker's grin" is caused by 2 technical errors: first, too much tension placed on the skin right at the corners of the mouth will cause a stretched appearance - instead, tension should be placed on the underlying muscle layer and the skin should be gently draped over the muscle without tension; second, the direction of pull should be diagonally upward toward the ear - this corrects down-turning corners of the mouth and can create a lovely "Mona Lisa" grin. However, if the direction of pull is horizontal then that will worsen the joker's grin. While people with very thin and delicate tissues, and those who have had multiple face lifts, are more prone to this sort of problem, it more often occurs with errors in technique. And worse yet, if they happen then they are very difficult, if not impossible, to correct fully which is why it's so important to have the right surgeon who has the best training, who is board certified in plastic surgery, and who has the skill, artistry and experience.All the best in your search!- Dr. Rad

Thank you for your question. Joker's smirk is an often-voiced concern of patients, however, the result is uncommon. Surgeons may make the mistake of overcorrecting laxity around the mouth by too much tightening that creates a slightly lifted appearance and upward smile. I suggest that you consult with a board certified facial plastic surgeon.Best wishes,

Joker's smile after facelift is usually the result of unnatural lateral pull of the skin during tightening and closure. Facelift techniques that tighten facial skin in a more superior fashion avoid this awkward result. Be sure to consult with a board certified plastic surgeon, good luck!

Dear springrolll,

Most often this comes about when the deep
layer (SMAS) is pulled too vigorously along the corner of the mouth. Although a
goal of the facelift is to smooth the nasolabial folds (folds that run from the
lateral nostril to the corner of the mouth) this is done with more traction on
the skin rather than the deep layers. Most of the pull on the SMAS should be
redirected so that it is primarily restoring the contour of the lower jawline.

I hope this has been helpful.

Robert D. Wilcox, MD

Hello Springrolll,The "Joker look" after a facelift is caused by too much pulling at the corner of the mouth.  This can be avoided both by the vector or direction the sutures are placed for the lift and where they are placed.  I'd recommend you consult with a facial plastic surgeon to go over your options and expected outcomes.I hope this helps and good luck.