I think what I have is called a jokers smile when I smile and I absolutely hate it! Do I need an implant of some kind?

Question

I have never had any plastic surgery. I will be 55 in May. The indents are small and only appear when I smile on each side of my mouth. I have great teeth and now I hate to smile. I look like someone painted an extra smile on me or something. Do I need an implant of some kind? Are my cheeks drooping? I smile and these indentations appear on each side of my mouth. Help!

Melvin Elson, MD · Answer

Since this appearance occurs with  muscle activity it is likely Botox will help but it is important to be evaluated by a board certified dermatologist who can watch the movement to know where to inject

Francis R. Palmer, III, MD (retired) · Answer

Hi, while non smiling photos of your face from the front and side (include a front smiling photo) will confirm this...you seem to be describing "marionette" lines forming due to the presence of "jowls" in the lower face. I have performed many facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  If you have "jowls”, in the lower face, these are sagging facial tissues and the main 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 SMAS facelift is the minimally invasive, short incision SMAS 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 from the face and neck
excess skin removed from the face and neck
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.  As the face ages, the fat and soft tissues over the cheeks begin to sag towards the nose and mouth which can make the cheeks appear flat or concave in the front.  When this occurs, the face appear elongated and either oval or rectangularly shaped. Following my beauty principles, 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.  When the cheeks are flat or concave 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.
 If the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.  I have found placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.
Hope this helps.

I think what I have is called a jokers smile when I smile and I absolutely hate it! Do I need an implant of some kind?

Answers (2)

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I think what I have is called a jokers smile when I smile and I absolutely hate it! Do I need an implant of some kind?

Answers (2)

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Everything you need to know about Radiesse

Our mission is to create a world where every investment in modern beauty is Worth It.