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      Descended Mouth Corner: An Ignored but Needed Feature of Facial Rejuvenation

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          Abstract

          For years, the gold standard in facial rejuvenation has been the face lift. However, exploring new, less complex procedures for achieving the same goal is currently drawing interest. Rejuvenation of the perioral area is a difficult task for plastic surgeons because of the minimal effect that face lift procedures have over this region and the lack of published material on the subject. In this article, the descended mouth corner anguloplasty technique is presented. It is a 20-minutes lift technique that can correct this typical feature of the ageing mouth. The authors have treated 71 patients using the technique with consistently good results, with just one requiring revision. They conclude that this procedure by itself and in combination with other small operations or even a full face lift can rejuvenate the ageing face.

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          Most cited references13

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          Elevation of the Corner of the Mouth Using Botulinum Toxin Type A

          Indications for botulinum toxin type A have been constantly evolving, and it can currently be used in virtually any area of the face and neck. The authors present their experience with this neurotoxin in treating the platysmal bands and depressor anguli oris muscle with the purpose of cosmetically improving the anterior neck and lifting the oral commissure.
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            Lifting lips: 28 years of experience using the direct excision approach to rejuvenating the aging mouth.

            The mouth ages along with the face, but it is frequently ignored when performing facial rejuvenation. The authors have addressed the mouth area with direct surgical options and excisions since 1980. In using the direct approach, the tradeoff for an improved appearance at a conversational distance is a scar that is barely visible from inches away. In more than 3000 procedures, the results have been consistently good, with very few minor scar irregularities that required revision. The authors advocate performing a lip lift to elevate the central lip and a corner mouth lift to elevate the lateral lip. Although the lip and corner lift are important in shortening the long lip of aging, one of the most useful perioral procedures is the direct excision of loose skin at the lower nasolabial/marionette foldover area. The authors conclude that results of facial rejuvenation are greatly enhanced by appropriate procedures of the mouth.
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              Rejuvenation of the aging mouth.

              Viewing the face as a series of three concentric rings, we can successfully rejuvenate the outer ring with the usual face lift, blepharoplasty, and brow lift. Insufficient attention has been paid to the middle and inner rings. The middle ring can be made to look more youthful by correcting the long upper lip with a lip lift, elevating the downturned corners with corner lifts, excising the deep nasolabial furrows, placing a chin implant to correct both the lateral chin-jowl indentations (the fleur-de-lis look) and the drooping chin, and dermabrading the wrinkles. The inner ring can be youthened by creating fuller lips either by the surgical augmentation techniques of inner flaps or vermilion advancements or by injection enhancement with a filler material. Our experience with 1300 procedures indicates that the successful rejuvenation of the middle and inner rings adds a great deal to appearance and satisfaction, the patient often appearing 10 to 15 years younger. Unknowingly altering a locus of identity in the mouth area can lead to significant patient upset and should be avoided. Guiding principles for cosmetic surgery around the mouth have been suggested.
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                Author and article information

                Journal
                Arch Plast Surg
                Arch Plast Surg
                APS
                Archives of Plastic Surgery
                The Korean Society of Plastic and Reconstructive Surgeons
                2234-6163
                2234-6171
                November 2013
                08 November 2013
                : 40
                : 6
                : 783-786
                Affiliations
                [1 ]Department of Plastic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.
                [2 ]Department of Plastic Surgery, Hospital de la Fuerza Aérea de Chile, Santiago, Chile.
                [3 ]Cienmanos Foundation, Chile.
                Author notes
                Correspondence: Pedro Vidal. Department of Plastic Surgery, Pontificia Universidad Católica de Chile, Lo Fontecilla 101 Of. 412, Santiago, Chile. Tel: +562-2207-1125, pvidalg@ 123456mac.com
                Article
                10.5999/aps.2013.40.6.783
                3840189
                24286055
                b9a333c1-575d-42db-acdd-d169b2ce417e
                Copyright © 2013 The Korean Society of Plastic and Reconstructive Surgeons

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 May 2013
                : 28 May 2013
                : 04 June 2013
                Categories
                Idea and Innovation

                Surgery
                surgery, plastic,rhytidoplasty,lip,lifting,rejuvenation
                Surgery
                surgery, plastic, rhytidoplasty, lip, lifting, rejuvenation

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