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Special Techniques For Rejuvenating Stubborn Mouth Corners

Posted: 6:00 a.m. Sunday, April 15, 2018

By Anita Mandal, M.D.
Question: I have droopy mouth corners. People always ask me why I’m sad, even though I’m a pretty happy person inside. A dermatologist did Restylane for my mouth corners, but I only got a small improvement. Then I went to a plastic surgeon, thinking he would be more skilled, and got Radiesse injections which weren’t much better. Is there anything that effectively improves puppet lines and downturned mouth corners so that I don’t look so sad?

Answer: While some ptotic (“droopy”) mouth corners are a simple fix using injectable fillers, others can be quite tricky to lift. Because multiple factors can contribute to a sagging mouth corner, identifying the correct cause is key to successful rejuvenation of a stubborn and ptotic mouth corner.

In many patients, a ptotic mouth corner is due to a simple downturn at the ends of the lip corners. As sagging progresses, jowls form and can further push down on the mouth corner, making it look even more droopy.

In other patients, vertical creases, also known as “puppet lines”, that drop straight down from the mouth corner to the jawline can develop from volume loss in the chin and jawbone. Filler can be injected directly into the “puppet lines” to restore a youthful appearance.

In simple cases, one can inject filler to lift the mouth corners. As aging progresses, this approach alone has limitations. One must also consider sagging and volume loss of surrounding tissues of the lower face which could be contributing. Filler to restore chin/jaw volume loss and lift ptotic mouth corners combined with Infini RF to non-surgically tighten loose jowls can give optimal results.

Another key consideration is the degree of laxity at the mouth corners. When stubborn ptotic mouth corners don’t respond to simple injection, they often need advanced injection techniques.

One advanced approach I’ve developed in the past 20 years is the 3-angle injection method where filler is specifically placed at 3 different angles towards the mouth corner – vertically, from the side and at a 45 degree angle. This technique can dramatically improve a ptotic mouth corner yet maintain a natural look.

Another effective approach is my serial layering technique where filler is injected in multiple layers, from deep to superficial, over 1 to 3 treatment sessions. Letting the injected areas settle for 3 to 4 weeks between treatment sessions is key to accuracy in the final results.

While injectable filler options range from stem cells, Radiesse, Juvederm and Radiesse, Bellafill – the 5 year filler – is the most commonly requested treatment for aging mouth corners in my office.

A skilled injector who is also a Board Certified Facial Plastic Surgeon and thoroughly understands the complex anatomy and causes of an aging mouth corner can help you get optimal rejuvenation results.


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