Upside Down Smile Not Improved After Facelift and Fat Transfer?

I had a facelift, neck, upper and lower eyes and fat transfer to fill marionette lines. I did not realize that my downturned mouth would not be helpped. Before the procedure, I could not smile. I still can't smile, my thin lips are not visible, and I look like an inverted yellow smiling sticker. I live near Denver. Can anyone send or direct me to before and after photos of something this severe and recommend a procedure or steps that can help?

Doctor Answers 11

Downturned corners of the mouth

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This is a problem related to loss of fat in the prejowel sulcus area from the inferior mandible to the corner of the mouth. A refilling of this area skillfully by an expert in fat injection will improve it immensely. A corner mouth lift operation does address this but a small scar at the corner of the mouth is left

Los Angeles Plastic Surgeon
4.7 out of 5 stars 30 reviews

Consider Corner of the Mouth LIft

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Contrary to patient perceptions, a significant downturning of the corners of the mouth will not be improved by any facelift technique. Now will any injection material drive up the corners of the mouth if they are more than slightly less than horizontal. In the really downturned commissures, a direct approach through a corner of the mouth lift is needed. This may be combined with vermilion advancements if one's lips are also extremely thin.

Upside Down Smile Not Improved After Facelift and Fat Transfer?

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  OK, I must confess that I'm confused.  From your posted question it appears that you still have jowls and Marionette Lines, with severely thin lips, after your Face Lift Surgery.  Without photos, of your face, I'm not sure how we could recommend anything at this point.  At the very least, aesthetically, you might want to have some form of Lip Augmentation and fillers to the Marionette Lines.  

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

Poor results after facelift surgery.

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Poor results after facelift surgery require you to send photos to  see what YOUR problem is specifically and then a proper answer can be made.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Downturned corners of the mouth don't always go away with facelift surgery

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The muscles at the corners of the mouth sometimes attach very strongly to the skin and the corners as well. Pulling the face back with a facelift doesn't always fix this. Other treatments are using Botox to relax the muscle called the depressor anguli oris, filling the crease or even a procedure called an angle of mouth lift. The surgical option is the most reliable but may leave scars along the corner of the mouth.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 141 reviews

Upside down smile better with filler or fat

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During aging, the corners of the mouth often descend creating a downturn to the corners of the mouth that makes you look like you're frowning.  This occurs in conjunction with deepening of the marionette lines and thickening of the jowl.  In my view, facelifting does very little to help with this problem.  Jowls and overhanging skin can be mostly flattened out but an artful facelift expressly AVOIDS distorting or changing the shape of the mouth.  Injectable fillers and fat injection can be used to build support for the corners of the mouth and fill in the marionette line area at the same time.  Frustratingly, this rarely eliminates the unwanted features but does create a noticeable improvement. 

Lawrence Bass, MD
New York Plastic Surgeon

You need to include pictures of your present status to get a realistic answer. It requires multiple views.

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There are several issues that can create a downturned smile:

  • You are "wired" so the depressors of your lips pull down.  This can sometimes be helped by carefull use of Botox
  • Your jawline is poorly supported and you have an uncorrected overbite which worsens the appearance of the folds as well as changing the dynamics of your lower lip muscles
  • Your upper and/or lower lips are too flat
  • etc.etc etc

A facelift and injections are sometimes not the answer.

Dr. Mayl

Fort Lauderdale

Nathan Mayl, MD (retired)
Fort Lauderdale Plastic Surgeon

Downturned Mouth Corners

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This issue can best be improved with a combination of lifting (i.e. face lift) and filling (injectables or fat grafting). You had these treatments done - so I would anticipate a significant improvement.

From study of faces I learned about the vast variation in our anatomy and aging patterns. Therefore, this global statement may only fit partially your esthetic situation. In some patients, deep marionette lines can be very difficult to erase. Other treatments, that are not "routine", can be used such as corner-of-the-mouth lift (a small surgical procedure) or weakening the depressor anguli oris (DAO muscle). This weakening can be done surgically as part of the facelift or with the help of Dysport or Botox.

Talk to your facelift surgeon what he would recommend to improve the remaining areas of concern.

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.6 out of 5 stars 48 reviews

Face lift post procedure and still with downturned mouth

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Facelifts can help this to a degree. Much of your aging is volume loss related. Around the mouth you can volumize to improve this appearance and this is not achievable with a face lift alone. I would consider fillers or fat injections or other newer volumizing procedures.

Philip Young, MD
Bellevue Facial Plastic Surgeon

Lip lift may be your answer

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Unfortunately the naslolabial folds and corner of the mouth are not improved significantly by traditional face lift surgery. A direct corner lip lift can improve this area directly. It is an in office procedure that has a quick recovery time. You need to be accepting of a small scar along the lip line but for most patients this is not perceptible.

Thomas Buonassisi, MD
Vancouver Facial Plastic Surgeon
4.9 out of 5 stars 114 reviews

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.