Smile surgery to help permanent frowns

A recent article in the Wall Street Journal highlighted a Korean Plastic Surgeon who is popularizing the so called Smile surgery. MSN News also recently featured an article about smile surgery, called a “smile lipt,” – a combination of the words “lip” and “lift.” While this procedure may sound odd, there are definitely some patients who are good candidates for this procedure. I have performed this procedure, also known as the Corner lip lift in my practice in Baltimore.

What is a smile surgery?

Some people have a distinct permanent frown type expression and Smile surgery can help them because it lifts the corners of the mouth.  The procedure is performed by Plastic Surgeons and it helps change the permanent sad or angry look to a more pleasant expression. This technique is different than a traditional Lip lift procedure, as that technique focuses solely on the long space between the upper lip and the base of your nose. A Lip Lift does not address the corners of your mouth. The Smile surgery focuses exclusively on lifting the corners of your mouth.

Since I do lip lifts and mouth rejuvenation quite often, I’d like to point out a few technical details for the procedure that addresses only the corner of your mouth and helps improve your smile.

Non-surgical options

Botox is a great option for those too timid to commit to a permanent procedure. This non surgical option is fairly popular. We inject Botox to the outer corner of the lower lip, where the Depressor Anguli Oris (DAO) is located. This muscle pulls the corners of your mouth down and out. When you weaken the muscle with Botox, the corner of the lip comes up naturally from the pull of the lip elevator muscles. You lose the ability to turn the corner of the mouth down for 3-6 months. It is not unusual for patients to have this procedure when they come in for Botox to the frown lines of the forehead.

Surgical options

1) DAO release

This procedure divides  and cuts the DAO muscle. It is more like a permanent Botox.  I performed my first DAO release in 2008 and was pretty excited about it at the time. However, I no longer perform this technique as I think cutting the muscle introduces unnecessary risk.  I think the Corner lip lift is a much better alternative . As with the upper lip lift, I prefer not to cut muscle, so I have moved away from this technique.

2) Corner lip lift

This is my procedure of choice to lift the corners of the lip. The objective is to re-position, upwards, the lateral commissure (where upper and lower lips meet) as seen on the illustration marked as an upward arrow.  On the left side of the picture we see the outline of the incision made to elevate the corner of the mouth. The arrow shows the direction that the corners are moved up. This is a very subtle and tiny movement.

It is important to keep two things in mind. First, you do not want to extend the lateral commissure out unless you have a short mouth. Otherwise, you can come out looking a little bit like the Joker. Secondly, the incision line on the corner of the mouth should not be too long because you want to keep the white roll of the vermilion border as long as possible.

I prefer the corner lip lift because it does not affect lip movement, which is very important for expressing a full range of emotions. In my practice we use it less often than the lip lift, but some patients find that after a successful lip lift they still want a more “uplifted” look, more of a smile. In those instances, the corner lip lift can be the perfect solution.

Can the Lip lift and Smile surgery be done together?

Yes, as stated above, some patients not only have long spaces above their upper lips, but the corners of their mouths droop downward. When desired from the outset, I can perform both the Lip lift and the Corner lip lift during the same surgical session.

Beautiful lips are often identified by a nice cupid’s bow and the perfect amount of space between the upper lift and the base of the nose. In this video I talk about Lip lifts, Lip augmentations, and avoiding the dreaded duck lips. Check it out and, as always, feel free to ask questions about smile surgeries and corner lip lifts in the comments.