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Key Points
- A downward turn of the oral commissure grooves can make a face look older
- When grooves are too deep for fillers to provide satisfactory results, the surgical technique described herein may be a desirable option
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Dr. Perkins
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In cases in which a downward turn of the oral commissure grooves contributes to an aged or otherwise undesirable look, relatively simple procedures can help restore a more youthful appearance, according to one expert.
"As the corners of the mouth draw down, it looks like frowning," says Stephen W. Perkins, M.D. "This can contribute to an aged, sad, tired or angry look in spite of the fact that a patient may have had successful cosmetic procedures on other portions of the face. Correction of the grooves gives a more youthful, fresher appearance." Dr. Perkins is the president and founder of Meridian Plastic Surgery Center in Indianapolis. He is also a past president of the American Board of Facial Plastic and Reconstructive Surgery.
TREATMENT OPTIONS According to Dr. Perkins, use of injectable fillers is the best and most common treatment for management of prominent oral commissure grooves because the procedure is noninvasive. With careful technique, standard injectable materials, such as hyaluronic acid, Restylane and Perlane, can fill deep grooves as well as provide some lift to the oral commissure. Under good conditions, patients may see satisfactory results for six to 12 months. However, there are instances in which the grooves may be so sharp and deep that injected material does not provide adequate lift to the area. In these cases, he says, surgical intervention may be indicated.
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The corner of the mouth lift provides an alternative to patients who desire a more permanent solution to the management of deep oral commissure grooves. If the grooves are deep and prominent, surgery may not provide 100 percent correction, but there is usually major improvement. And incases of the elderly patient, this lift may also serve a therapeutic purpose in the treatment of angular cheilitis, a chronic inflammation or infection in the corners of the mouth. This condition is brought about by constant drooling and may be exacerbated by the downward turn to the oral grooves.
TECHNIQUE IN DETAIL Dr. Perkins tells Cosmetic Surgery Times that the incision areas for the corner of the mouth lift should be marked while the patient is either seated or in a semi-recumbent position. From a dot placed at the oral commissure at the junction of the skin and the vermilion, a line is extended medially and diagonal to the superior aspect of the tragus, for approximately 1 cm but not to extend past the natural cheek-lip crease. A second line, equal in length to the first, is then drawn superiorly and medially from the original dot along the vermilion border. The two lines are then connected in a convex curvilinear fashion to form a triangle-shaped section of skin — approximately 7 mm in height, but no more than 9 mm — to be excised. Asymmetrical areas on either side of the mouth can be accommodated by slight adjustments to the markings.
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Surgery is performed under local anesthesia with sedation and usually takes 20 to 30 minutes. The triangle of full thickness skin tissue is excised to the level of the orbicularis oris muscle but not into the actual muscle fibers. After hemostasis is obtained, 5-0 Dexon is used to close the wound from the oral commissure to the middle of the superior curvilinear line. The remainder of the wound is then approximated and everted with 6-0 Dexon sutures. The skin is closed with 7-0 Prolene running suture.
