Downturned Corners of the Mouth:  How To Fix Them

One of the banes of women’s existence is the downturned corners of the mouth. Whether they are mildly present or severe, almost every woman regardless of age is overly focused on them to their own detriment. I often think that the reason for this is that women look too closely at the mouth when they put on lipstick and then have this weird association where they think minor aging of the lips reminds them of their mother, causing psychological panic that is typically disproportionate to the problem at hand.

I have tried everything for these downturned corners without perfect success. In the past I would perform a corner of the lip lift, a surgical procedure to lift it, but without great success. I have tried facelifting the area but without success. The only thing that I have had success to improve but not to eliminate the fold is with fillers like Restylane (temporary) and Artefill (permanent).

Improvement in the "puppet line" and downturn of the lip but not full correction, which is oftentimes impossible to achieve

What I typically can accomplish is to make the fold change in shape from 45 degrees downward to near horizontal in non-extreme conditions; but I cannot entirely get rid of it.  This limitation is very important for you to understand before I begin trying to fix the problem.  As a complement to that treatment, injection of the depressor anguli oris (DAO) with Botox can sometimes atrophy the muscle enough that the corner can lift somewhat as well but not with the reliability as I have with fillers.  Combining both techniques can be more effective.  The goal with the Botox injection of the DAO is to atrophy the muscle, i.e., weaken it, so that over time the corner may lift for a longer period of time if not indefinitely.

Sam M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. Call (972) 312-8188 to schedule a consultation or to ask Dr Lam a question please visit our plastic surgery forum.

Understanding The Importance of Lip Transitions When Creating Natural Looking Lips

I have been thinking about transitions from the red lip to the non-red lip because of two women that I saw in the past few days.  First, there was a woman who came from Oklahoma that had these hanging red lips towards the corners of her mouth that looked like a fish.  She had only those side areas injected with silicone because she wanted to make them look fuller.  But a natural lip should taper gently to nothing as it reaches the corners of the mouth.  Instead, hers bulged as it reached the corner of the mouth.  I performed a lip reduction to correct her problem.  The second lady that I saw insisted on having fillers placed into the sides of her lips because she said she drooled at night.  I explained that functionally I do not think filling those sides would help her not drool but more importantly it would look terribly unnatural.  Remember that I truly understand how lips should naturally look, and I ask you to defer to my better judgment when designing your lips so that they stay natural in appearance to all passersby.

Lips that fail to taper to the corners of the mouth look unnatural, which has been corrected through surgical lip reduction.

Samuel M. Lam, MD, FACS is a board certified plastic surgeon, specializing in lip reduction and lip enhancement procedures . For more info, or to schedule a consultation please call (972) 312-8188. If you would like to ask Dr Lam a question please visit our lip surgery forum.

Concerns After Lip Reduction: Revisited

Since I perform a very large number of lip reductions, I have worked hard to discuss with individuals all of the risks, complications, and recovery issues that I can imagine and that I have experienced over the years.  This blog article will discuss what I have encountered so that hopefully as many of your answers to your questions can be found before having a procedure done with me.

First we will address recovery issues that I think are helpful for a prospective patient to be aware of.  The number one concern that individuals have is how long will they be swollen.  This is a hard one for me to answer because swelling is variable.  I have seen as little as a few days and as great as a few months.  However, in general it is about 1 to 2 weeks of unfavorable swelling with the worst being the first several days.  In fact, the lips can swell after the first few days to be much larger than they were even before the surgery, a fact that can be alarming.  This is normal.  I repeat this is normal.  Most people take only a week off from work for practical reasons but must understand that there can be ongoing swelling into the second week.  For ethnic lip reductions, the worst that I have seen for duration of swelling was 5 weeks but this was in a woman who had a very very large lip reduced and I have yet to encounter that long a time for swelling in another ethnic individual.  For correction of previous bad silicone I have see up to 5 months of mild fluctuating swelling but that one woman had swelling that was already present before I performed her lip reductions so I believe this is an atypical case.

Corrective Lip Reduction for Aquamid

Another concern is how long will the lips have visible sutures.  Typically again this is for 1 to 2 weeks.  It is imperative that the sutures not be trimmed during the first week and only sutures that are hanging loose be trimmed after the first week.  Allowing sutures to dissolve by themselves is the key.  Also the incision for the first several weeks can be hanging outward more until the swelling starts to dissipate.  This is normal.   If the lip has some bleeding in the first week or two, that is normal.  All you have to do is hold pressure.  It will stop.  If a suture becomes unraveled early and even if the wound slightly opens, it should still heal fine.  This happens in a few cases.  The lips can also feel very numb afterward and even stay relatively numb for a few weeks to months, which should not raise alarm.  The lips can also feel tight, especially when opening one’s mouth or smiling and this can last for several weeks and at times even somewhat for several months.

Risks of a lip reduction include but are not limited to over or under reduction, scarring, and asymmetry.  I always tell my patients that it is very important for them to trust me on how much lip I can reduce because any more or any less may be a problem for them.  Too much lip reduced and the person could have a gummy smile, lip incompetence, a tight feeling or look unnatural.  Too little lip reduced and no result could be visible.  Given these limitations I always suggest that if one would need a further lip reduction that he or she wait for at least 6 months before contemplating any further reduction (for which I would not charge for the added procedure) because healing may be delayed with too quick another reduction and the risk of overreduction is then possible with all of the attendant problems enumerated above.  I only need to perform a further reduction in less than 5% of those who undergo lip reduction with me.  However, it is fully in my discretion to decline an individual in whom I think the risk is too great to undergo another reduction.

I have had two patients with scarring, and they were both African-Americans.  The scarring was only about 1 mm of thickness at the incision line and was easily handled with 1 to 2 rounds of 5-flourouracil injections.  Unfortunately, I am one of the few people who know how to do this procedure so you may have to fly back for me to do this, which you would be responsible for any incidental and travel expenses but I would not charge you for my services.  Fortunately, I have only had 2 cases of this out of several hundred so the odds are favorable that there will be no scarring.  As a reminder, an actual keloid is near impossible on the face even if you have a history of them on your ears, neck, scalp, or body so I am not concerned about that.  Asymmetry is very unlikely, and I do not remember having a case of this occur but obviously it is always a risk.  More often than not if you see asymmetry it is either something you had before (so please look at your lips carefully before having a procedure with me) or is very slight and should not be noticeable on normal social or professional distances.  I hope this extensive catalog of the risks. limitations, and recovery issues following a lip reduction procedure with me was helpful for you.

Samuel M. Lam, MD, FACS is a board certified plastic surgeon, specializing in lip reduction and lip enhancement procedures . For more info, or to schedule a consultation please call (972) 312-8188. If you would like to ask Dr Lam a question please visit our lip surgery forum.

Jody, Dr. Lam’s patient, gives her testimonial 1 year after her upper and lower lip reduction procedure and talks about how it has changed her life.

Megan Fox’s Lips

In general, I am not opposed to a more aggressive policy with lip augmentation for women in their late teenage to early twenties.  A full set of lips can actually look natural in this narrow window of time.  However, even by the late twenties when the face is slimmer, very full lips can look artificial.

Megan Fox’s Lip Augmentation

That is why I prefer to use only temporary fillers like Restylane and Juvederm for lip augmentation in very young women.  Also, it helps to ensure that when the lips age that things will age gracefully and naturally.  Even though this is the case, looking at Megan Fox’s lips, I would say that the after results are still too much for my taste.  Despite following these principles of lip and face aging I have expressed, taste and artistry still take precedence when working on a person.  I think the shapeless over exaggeration in this case is not ideal in my opinion.

Understanding age appropriate lips and how to achieve good-looking shape that also fit a person’s face are keys to working on an individual for lip enhancement.  Unfortunately, I wind up performing more lip corrections on other’s physicians’ work than I perform natural lip augmentation.  Sad statement about lack of judgment today.

Samuel M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To learn more about Dr Lam’s lip surgery procedures please visit our website www.LamFacialPlastics.com or call (972) 312-8188 to schedule a consultation.