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The relative positions and shape of the lips and corners of the mouth signify ones age or youthfulness and emotional status (happy, sad, angry). As one ages the upper lip thins, sags and wrinkles. Skin folds or marionette lines appear extending downward from the corners of the mouth and those corners slant downward. The earliest approaches to this area were the surgical facelift and lip lift surgery that removed or repositioned tissue around the mouth specifically removing skin in the area where the lip joins the lip skin (vermilion advancement) or removing skin just beneath the bottom of the nose. The results of doing so however were variable and the scars can be disfiguring. Later came chemical peels and lasers to remove aging wrinkles of the lips. In the 1980s doctors began injecting botox into the muscle that pulls the corner of the mouth downward (the yellow circle in the video below). This gave subtle but temporary results as did injectable fillers in the corners of the mouth. All of the direct surgery to the corners of the mouth that I have seen in the US have had disastrous results with bad scars and/or bizarre appearances with movement.
Now, from the country that has the most per capita plastic surgery, South Korea, comes the corners of mouth lift. They call it "Smile Lipt" surgery.
In the video it is apparent that when the surgery gives a subtle result it does look good but when done more aggressively makes the patient look like the Joker character from Batman or the main character from Vendetta. Overall the results are better than have been the norm in the US because they appear to focus on the muscles in the corner of the mouth instead of the skin and fat tissue at the corner of the mouth. These skin and fat removal procedures include the “Valentine anguloplasty” after the heart shape of the removed skin at the lip’s edge. That is not to say that muscle surgery alone is better because removal of muscle in this area can create indents.
Patterns of skin removal for lifting drooping corners of the mouth in the West including the valentine anguloplasty and the lentiform excisions. The far right excision pattern includes removal of the marionette line itself and should be reserved for very light skinned patients that have deep marionette lines.
This newly popular surgery has been receiving increasing news coverage.
Face and Neck Lift 1
Face and Neck Lift 2
Aaron Stone MD - Plastic Surgeon Los Angeles
Aaron Stone MD - twitter