Rejuvenation of the perioral area has been always a difficult task for plastic surgeons performing face lifting procedures. The difficulties that we have to face in the perioral area are superior lip vertical lines, thin lips, a lowered corner of the mouth, deep nasolabial and marionette lines. Typically, face lifting procedures do not usually address these factors although this area is one of the first to show signs of aging such as upper lip descent and lengthening, loss of bony support, elasticity and skin turgor (tonus).
One of the main characteristics of aging mouth is the sad appearance because of the lowered mouth corners in a form of an inverted U. The look is sometimes called ‘’sad mouth’’ and can be quite upsetting for the patient. The patient is tired of explaining that he/she is not sad or in the bad mood. The lowered mouth corners later turn into the deep marionette lines or melomental folds that lead downwards and sidewise from the mouth commissure (mouth corner). The look sends negative sensations of sadness, disagreement, unkindness and melancholy and produces inverted smile also known as ‘’Chinese moustache’’. The main cause for the inverted smile is an overactive depressor anguli oris muscle.
Procedures for the corner mouth lift:
- Botulinum toxin injections into the muscle m. depressor anguli oris- are less efficient, because of the proximity and intertwine with another muscle, i.e. m. depressor labii inferioris; the procedure requires a really well trained surgeon.
- Plication of SMAS aponeurosis above the angle during a full facelift.
- Marinetti –Little procedure consisting of intraoral mucosa resection.
- Weston ”wraparound” corner mouth lift – direct excision of the skin above the descended corners, which is quite a frequent procedure.
- Valentine anguloplasty technique Flowers-Ceydeli – a lop-sided heart shape skin is removed from the corner of the mouth, and when the skin is sutured, the negative line becomes a positive one. This is the most frequent procedure performed in our clinic.
- ‘’Optimistic sutures’’ – the mouth corner is elevated with a suture between the base of the nose and lip commissure. What an elegant procedure!
Potential complications: insufficient tissue resection, which can be corrected later and more or less visible scar, depending on the organism reaction. Generally, the scarring becomes less visible with time and the patients’ satisfaction with the procedure is mostly very high. Infections and bruising are possible, but occur quite rarely.
Post-operation instructions:
The sutures are removed five or six days after the procedure. The patient could apply moisturising cream several times a day. We advise minimal chewing when eating and no laughing for a week or two, as it presents stress for the fresh wound. A week after the procedure the patient can use makeup.
