I have a very sad mouth that when relaxed my lips don’t meet and never have. Options? (photo)

Question

I also have hollow cheeks. Not ready for face lift but read on here That it doesn’t correct a sad mouth anyway & as said my lips have never met. Would appreciate some advice.

Jed H. Horowitz, MD, FACS · Answer

Hello anon2242934There various procedures available, i would advice you schedule a consultation with  board certified plastic surgeon.

Benjamin Caughlin, MD, FACS · Answer

It appears that you need volume. There are many ways to accomplish this goal, from fillers to fat transfer, and it will make a modest improvement. Ultimately we cannot change anatomy with these treatments, but can augment what you have. A small amount in the lips, some at the corner of the mouth, and then enough in the cheeks for a slight lift would look nice. 
Hope this helps.
Best of luck,
DrC

Jason Emer, MD · Answer

A downturned smile or permanent frown can be improved with a combination approach, including neuromodulators (such as Botox, Dysport, and Jeuveau), injectable fillers, and radiofrequency skin tightening treatments such as Thermage or Venus Legacy. I recommend getting a formal evaluation with an experienced cosmetic dermatologist to develop a treatment plan that works for you. Best, Dr. Emer.

Daniel Levy, MD · Answer

Your down-turned mouth corners and hollow cheeks can be corrected with a liquid lift, a strategic combination of injectable treatments. To start, I would use Voluma to contour and lift your cheeks, and Botox to relax the muscles that are pulling down the corners of your mouth.Good luck!

Manolis Manolakakis, DMD, FACS · Answer

from the photos you have provided I would recommend some Botox to relax the mentalis and depressor anguli oris muscles. This would help but honestly, if you were my patient I would not operate until you were ready for a facelift. The opinion that a facelift doesn't correct a sad mouth doesn't make sense. If a sad mouth is becoause of the downturned mouth and jowling, then a face and neck lift is exaclty the answer. The lips not touching can be from other skeletal deficiency such as small chin or receded lower jaw. But I can not comment on that as I don't have that info. Best of luck Dr M

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

Hi, I have performed many facial shaping procedures, including Chin Augmentation with dermal fillers or silastic chin implants, for over 30 years.  From the photo, your chin is quite weak and "jowls" are present (which will be discussed below).  When the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy, the lower face looks short, de-emphasizes the lips and allows early formation of a "double chin".  
 Proper placement of a silastic chin implant adds forward projection to the chin thereby creating harmony and balance to the lower face.  Using the same incision, liposuction can be performed to reduce the fat and further shape the neck.  Excess skin, from below the chin, can also be removed through the same incision.  
 I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick, highly effective and far less invasive than a sliding genioplasty (requires extensive tissue dissection, bone cuts and placement of metal screws and plates to secure the cut segments of bone).  I perform chin implant surgery in 30 minutes or less, often using a local anesthetic alone.  In my opinion, you are a good candidate for chin implant surgery.  You mentioned that you are not ready for a facelift.  In that case precise placement of a dermal filler can soften the "marionette" lines that are formed by the "jowls" in the lower face.  I have performed many SMAS facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  "Jowls” 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. 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 concave or flat in the front, cheek augmentation with a dermal filler or using silastic cheek implants for a permanent enhancement can create full, round cheeks that will feminize the entire face.
Hope this helps.

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