Relaxed or raised corners of the mouth signal calm, open-mindedness and friendliness. Hanging corners of the mouth convey sadness, tiredness and a pre-aged appearance. Eight different muscles unite at the sides of the corners of the mouth. The common approach of the muscles in this area is called modiolus. The muscle whose tension predominates shifts the corner of the mouth in the direction of traction. Two muscles can lift the corner of the mouth: the Musculus zygomaticus major and the Musculus levator anguli oris. In contrast, the lowering of the corner of the mouth is controlled by the muscle depressor anguli oris and the platysma.
The shape of the upper jaw changes with age. This increases the distance between the nose and mouth. The skin of the mouth area is also subject to the aging process. The skin becomes thinner and loses collagen. The skin's elasticity decreases. These changes are accelerated by cigarette smoking. One of the first signs of aging is the sinking of the upper lip and the corner of the mouth. These changes cause the lips to lose fullness. The skin above the upper lip hangs and folds. The red of the lips becomes thinner. The face loses its youthful contours and the corners of the mouth fall off. Patients in whom the corners of the mouth are sagging due to aging or heredity can benefit from a correction of the corners of the mouth.
The corner of the mouth is lowered by the predominant tension of a muscle, the musculus depressor anguli oris. When this muscle is relaxed with Botox, the corners of the mouth are lifted under the influence of the opponents. The muscle depressor anguli oris, which lowers the corners of the mouth, lies 8-15 millimeters below the corner of the mouth. Two to four units of Botox are superficially injected per side. Depending on the characteristics of the hanging corners of the mouth, the Botox is injected in one to three places. The effect lasts four to six months.
Hyaluronic acid fillers give the lips more volume and a beautiful shape. Wrinkles on the upper lip as well as lateral wrinkles in the mouth can be smoothed. The targeted injection of filler below the corners of the mouth can lift hanging corners of the mouth again. Using a very fine needle, 0.05 to 0.1 milliliters of Filler are injected along the lip red border of the lateral lower lip. Then 0.1 to 0.15 milliliters of hyaluronic acid are injected just below the corner of the mouth. Injecting in this area is very effective in compensating for vertical wrinkles at the corners of the mouth, the so-called marionette wrinkles or mentolabial folds. To obtain a natural, sweeping shape of the corners of the mouth, 0.2 to 0.3 milliliters of filler are injected into the outer upper lip. The treatment only takes a few minutes and lasts for about six months.
We strongly advise against lifting the corners of the mouth with a thread lift. The benefits of this treatment are very controversial and the risks are not insignificant.
The plastic surgeon will first listen to you carefully to understand your concerns. In addition to your specific concern, you will also be asked questions in order to recognize any risks in good time and to be able to better prevent them. Since many personal characteristics influence facial expressions, the examination also extends to other areas. The surgeon takes into account the nature of the skin, facial muscles, jaw malposition, the length and depth of skin wrinkles, the volume of the lower lip and upper lip, and the alignment and position of the corners of the mouth. Slight lateral lip imbalances even when laughing are not unusual but worth noting.
After an exact finding has been made and your expectations have been discussed, approaches to solutions are developed. Since many parameters influence a treatment result and every person is unique, there is no standard solution for everyone. As plastic surgeons specialized in facial surgery, we can offer you the most suitable treatment from the possible conservative as well as operative methods. During the consultation you will be shown which goals can be achieved with the respective treatment. Since every treatment is also associated with certain risks, the advantages and disadvantages of the procedure and the treatment costs will be discussed with you in detail. Since questions may arise after a comprehensive consultation, we always offer a second consultation before the procedure.
The lifting of the corners of the mouth is performed in a short procedure under local anesthesia. An overnight stay at the clinic is not necessary. Before the procedure, the new position of the corners of the mouth is marked with a fine marker. The surgical plan is meticulously recorded, measured and checked several times. The local anesthetic is injected with a very fine cannula. The previously marked excess skin is removed under magnifying glasses. A small part of the muscle that lowers the corner of the mouth is removed. The skin is meticulously and precisely closed with very fine sutures. Clamp plasters are applied, which are renewed the next day. Before you leave the clinic, you will be given a report in which, among other things, precise behavioral measures are recommended. This report will also contain appointments for follow-up and a telephone number where you can reach your surgeon at any time in an emergency.
Every treatment is also associated with certain risks, which will be discussed with you in detail in advance. Correction of the corners of the mouth is accompanied by a scar, which in most cases heals well and is hardly visible after a few months. Scars can be raised and reddened in the first months. Microsurgical techniques and fine suture material prevent bulging scars from forming. Due to the nature of the condition, scars can be visible despite consistent care. Cortisone injections can be helpful to reduce scar growth. Perfect symmetry is always strived for, but cannot be guaranteed 100 percent. If you have already had cold sores in the past (herpes inflammation), lip herpes can recur after an operation. In these cases the preventive use of Acyclovir should be considered. The risk of wound healing disorder or inflammation is less than one percent, but is generally increased in smokers (Jeong T.-K., 2020, Plast Reconstr Surg Glob Open).
Especially in young patients, a stronger scarring is occasionally observed. Various measures can reduce this risk. Fine, tension-free sutures, staple plasters, scar massages and consistent sun protection have a positive effect on scar formation. A wide mouth opening, for example when yawning or laughing, should be avoided in the four weeks after the operation. The skin sutures are removed between the sixth and seventh postoperative day. Make-up should be applied on the tenth day after the surgery.
On our cost page we provide information about the scale and composition of the costs. The duration of an intervention and the treatment effort vary depending on the findings. Following the first consultation, we can prepare an offer tailored to your needs.