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CosmeticSurg Blog

Dr. Rodriguez discusses Plastic Surgery, Medicine, and Stem Cell Research

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 logoBotox 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

DAO Release

facial muscles surrounding lipsThis 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.

Corner Lip Lift

smile surgery illustrationThis 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.

By Dr. Ricardo L Rodriguez
Board Certified Plastic Surgeon
Baltimore, Maryland
Ricardo L Rodriguez on Google +

Posted in Face

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23 Comments

  • wrote
    September 17, 2014 at 8:36 am

    MJ:
    I cannot say for sure if the downturned lips are from Botox to the masseter. The masseter muscle is not related to the muscles of expression and is in the back of the jaw right in front of the lobule of the ear. Something else may have happened or what was injected was not the masseter.
    The cause of down turned lips is complex. Of course aging is the biggest factor, but fat atrophy in the area around the lip is also a factor.
    In any case, it seems you are a good candidate for “corner lip lift”. The corner lip lift will not rejuvenate your entire face, it only affects the corner of the mouth but it’s effect is noticeable. I have not seen you in pictures, and you may want a virtual consult, but a lip lift may also help and that has a more general effect, especially when combined with the corner lip lift. I’ll have Kelly at kelly@cosmeticsurg.net contact you for any more questions you might have.

  • wrote
    September 16, 2014 at 7:31 pm

    Hello Dr. Rodriguez,

    I have downturned lip corners. I never noticed this until I turned 40, after a Botox injection of the masetter muscle about a year ago. I have not gotten any more botox since then as I did not like my lip corners turned downward. I thought I have downturned lip corners because of skin laxity in the buccal area. Is corner lip lift also a good option for facial rejuvenation? I wasn’t born with downturned lips. Thank you!

  • wrote
    September 7, 2014 at 3:58 am

    I really like your way of expressing the opinion and sharing the information.

  • wrote
    July 21, 2014 at 3:48 pm

    Thank you Dr. Rodriguez. That makes sense (lower lip looks fine after upper lip lifted). I will contact Kelly for more questions or appointment.
    Thank you for your comment. Look forward to seeing you soon.

  • wrote
    July 13, 2014 at 2:43 pm

    Sara:
    Although practically every patient that has a lip lift asks for something to be done to a lower lip, I find that once the upper lip is lifted the lower lip looks fine. I offer patients to do a corner lift or something for the lower lip later, but the truth is only a few ask for a corner lip lift after the upper lip lift has been done and nobody to date has asked for something to the lower lip.
    I will let Kelly at kelly@cosmeticsurg.net so she can give you more info.

  • wrote
    June 6, 2014 at 11:50 pm

    Hi Dr. Rodriguez,
    I am thinking about getting a lip lift (along with corner lift and botox for DOA release). I also would like to improve my lower lip. I am wondering if you perform a V-Y plasty on lower lip? I know the filler is the option but I’m looking for something permanent without putting anything foreign to my lips.

    Thank you,

  • wrote
    May 18, 2014 at 1:54 pm

    Ms. E
    Everybody gives names to their procedures as a way to make them easier to remember by patients.
    I do anguloplasties frequently. The most important thing is not to extend the length of the lip which is what I think a lot of surgeons do when they do a corner lift. I think that creates too much of “smile” and looks unnatural. I agree with you, the only objective is to eliminate the downward turn. Contact Kelly at kelly@cosmeticsurg if you are interested in more info.

  • wrote
    May 18, 2014 at 1:54 pm

    Ms. E
    Everybody gives names to their procedures as a way to make them easier to remember by patients.
    I do anguloplasties frequently. The most important thing is not to extend the length of the lip which is what I think a lot of surgeons do when they do a corner lift. I think that creates too much of “smile” and looks unnatural. I agree with you, the only objective is to eliminate the downward turn.

  • wrote
    May 18, 2014 at 1:49 pm

    Allison:
    We get a lot of patients from out of town. We have several from Europe, including patients who knew about me but decided to stay nearer to home and get the procedure done but were not satisfied with the results.
    As far as the corner of the mouth it may be the way you move your muscles when you speak. Try to adjust the way you speak while standing in front of a mirror. You will be surprised at you much you can accomplish. Actors train themselves to imitate facial mannerisms and facial quirks, so you can do it too.
    If you are interested, we can set up a virtual consult.

  • wrote
    May 6, 2014 at 6:32 pm

    I would love to see actual photos of your corner lip lift.
    Have you done a Valentine anguloplasty perfected by Dr.Flowers, & currently done by Dr. Cedeli? I equate the smile lipt popular with Asians, which I don’t want. I just want to rid my frown. Thank you.
    Ms.E

  • wrote
    May 4, 2014 at 10:07 am

    Hi Dr. Rodriguez,
    I have been researching lip lifts for quite a while now as I am very interested in having one done and in all my searching it seems that all arrows point to you when it comes to the best surgeon for the job! I would love an upper lip lift to help with a long upper lip and no tooth show or natural parting of the lips when mouth is at rest. My question however is regarding the corner lip. One side of my mouth pulls downward when I smile and speak and it really bothers me! It’s not noticeable when my mouth is at rest however. What would you recommend for this? I so wish I was closer to your location!!

  • wrote
    January 29, 2014 at 10:53 am

    Jacinthe:
    Ça va?
    We get many patients from Canada (y compris beaucoup de francophones!)
    Kelly, at kelly@cosmeticsurg.net will be happy to help you arrange a virtual consult. We can use Skype or FaceTime, and I’d be delighted to speak to you.
    À Bientôt!

  • wrote
    January 28, 2014 at 6:44 pm

    Hi Dr. Rodriguez,

    I live in Montreal and I am interested in having a lip augmentation volume and lifting. Could you please tell me how we can arrange a consultation?

    Thank you!

  • wrote
    January 12, 2014 at 6:38 pm

    Chehrazed:
    Is this a Persian name?
    I have forwarded your email to Kelly, she will be able to help you out.
    Looking forward to hearing from you.

  • wrote
    January 8, 2014 at 3:08 pm

    my name is chehrazed, i am from Montreal,i want to now the price of Mouth corner lift/
    thank you

  • wrote
    November 3, 2013 at 1:01 pm

    Cristina:
    Sorry for the delay, I have been in a medical mission trip to Armenia and just got back.
    We do get lots of out of town patients. Some see me the day before, some the day of surgery.
    We’d love to chat with you, contact Kelly at kelly@cosmeticsurg.net and she will give you details about pricing, travel, etc.
    Ideally, we could Skype or FaceTime (if you have iPhone or Mac) to get a better idea of your goals.
    Looking forward to hearing from you!

  • wrote
    November 3, 2013 at 12:56 pm

    Hello Laura!
    Sorry I did not get to this before, I was in a medical mission trip to Armenia and just got back.
    This procedure achieves precisely what you are looking for.
    I would look at my previous posts on this one on technique, and others that you can find here
    Contact Kelly at kelly@cosmeticsurg.net and she’ll be more than glad to send you info and set up a Skype session if you are interested.

  • wrote
    October 18, 2013 at 11:50 am

    While doing self portrait drawings in an art class we were learning about facial proportions and shapes of facial features. My art teacher pointed out in class that student XYZ always looks like he is smiling because the corners of his mouth naturally turn up, while if you’ll look at Rebecca’s mouth, it looks like she is frowning because the corners of her mouth naturally turn down. That statement and realization has haunted me ever since and I was very interested in this article as there may be hope to correct my infinite frown, which has never been a true reflection of my feelings or mood.

  • wrote
    October 14, 2013 at 2:59 pm

    I would like to do the corner lip lift, I don’t live in Baltimore but will trave there to do it, can you tell me more or lest the price of this procedure.
    Thanks in advance, and please let me know what are the times available to see the doctor perhaps next week, and can I see the dr and have the procedure the same day?
    Thanks
    Cristina

  • wrote
    October 7, 2013 at 9:05 pm

    Hi, I am happy with the shape of my lips but would like to shorten the distance between the nose and top lip, would this procedure work well for that? Would it change th shape of the lip dramatically?

  • wrote
    October 7, 2013 at 2:12 am

    Thank u so much for replying! I honestly can’t wait to get them done. Ill be seeing you soon i guess :)

  • wrote
    October 3, 2013 at 11:08 am

    Rebecca:
    The scarring under the nose for the main lip lift is almost invisible and on some patients you literally have to get up inches away from the face and stretch the skin to see the scar. On practically every single patient that comes for a 4 month post op visit, if I have not seen the chart I cannot tell I did a lip lift unless I look at the pre op photos.
    The corner lift is a subtle scar because it is at the corner of the lip. A trained eye can see it but I doubt anybody else will. I am doing the corner lift more and more, but it is definitely less common than the conventional lip lift.
    The short answer to your question is that people close to you will know you look different but will not be able to pinpoint what it is.
    Call Kelly! She’ll be happy to help you at kelly@cosmeticsurg.net

  • wrote
    September 27, 2013 at 5:12 pm

    i’m really interested in getting the corner lip lift done along with the upper lip lift Dr Rodriguez. Can you tell me if either of them leave any obvious scarring? Will anyone be able to tell i had these surgeries done?

    Thank you

    R.