Yes, we plastic surgeons have entire articles in journals about lifting the mouth corner. It is sad, but as you age and your face droops, your mouth starts to turn downward. This often makes people look sad or angry when they are not. And it is just normal aging. There is a fold which can form as well, which we call the “marionette lines.”
This was a study in the Aesthetic Surgery Journal August 2022, a review article, “Lifting the Mouth Corner: A Systematic Review of Techniques, Clinical Outcomes, and Patient Satisfaction.” Review articles are never earth shattering science, but I like them as they find all the options out there.
Study: They found 968 studies, but only 11 were analyzed. They concluded “in general surgical techniques seem to have better mouth corner lifting effect than non surgical techniques: however objective evidence is weak, and surgery inevitably results in a scar.” The study said patients reported being satisfied with both surgery and nonsurgical techniques.
They stated the indirect techniques of facelift and threadlifting did NOT significantly change the mouth corner. They discussed when it did lift the mouth corner visibly, there was a risk of the “Joker” mouth.
Surgical techniques: DIRECT
- Lentiform excision
- Triangular excision with DAO muscle transection
- Advanced Z plasty
Surgical techniques: INDIRECT
- Classical facelift
- Threadlift
- Autologous fat grafting
NonSurgical
- HA filler injections (Restylane, Juvederm, etc)
- Botox injections into the DAO (depressor anguli oris) muscle
My thoughts?
I hate visible scars in places where it is hard to hide them. In this case, I like fat grafting (read my plethora of pages and blogs on why I love fat grafting) in the OR. I have photos (my face photos are all shown in the office for patient privacy) which can show you what fat grafting can do. I find it to be super successful for the mouth downturn and marionette lines.
In the office I like dermal fillers. I am starting to try the Botox injections in the DAO. I read and blogged about the study they cite. It makes sense to me. The problem with all the nonsurgical techniques is they need to be repeated. But fat, filler, and Botox all help this problem without scarring.
I think it is an important area to fix. Without it, that mouth downturn makes you always look a little sad or mad. Given the “weak” evidence with the direct surgical techniques, and the fact they put a scar which I consider visible, I am going to stick with fat grafting in the operating room, and filler and botox in the office.