Turn Your Frown Upside Down with a Marionette Excision.

Woman with her hand on her face

Like the rest of the face, the mouth area deflates and sags with aging.  The upper lip rolls inward  and as the mouth corners turn down, the loose skin and tissue to the side of the mouth falls forward creating what is known as a marionette fold. These changes also deepen the corners of the mouth creating deep creases (oral commissures). The combination of both of these effects can create an inverted U-shape to the mouth, making it look aged as well as sad.

While fat injections, biostimulators like Sculptra and long lasting fillers like Bellafill can help to restore volume, older patients lack the skin quality to maintain the lift these options provide.

Will a facelift help?

The mouth is far away from the pull of any traditional method of skin lifting such as the lateral pull of a traditional facelift or the superior pull of a midface lift.  Adding fat to the face to help fill and support sagging skin can help, but the improvement to the sides of the mouth and marionettes folds is minimal.  Any improvement to be had is short lived and minimal due to  stretched out and thin skin that most elderly have.

What are my options?

The corners of the mouth can be lifting in a simple procedure that removes small triangles or heart-shaped segments of skin just above the oral commissures.  With this incision, the mouth corners can be immediately and simply repositioned.  This procedure can be done as a single procedure or combined with a facelift.

While a corner lift can improve the downward turn of an aging mouth, it does not affect the creases caused by the hanging marionette folds. This area requires a little known procedure called a marionette fold excision.  It may seem aggressive, but in the elderly patient with thin and inelastic skin, the scar can be quite thin and heal inconspicuously.  

While its best to try to improve the sagging mouth and marionette folds with injectable fillers first, the age of the patient and the severity of the downturning may justify skipping these and going straight to excisions for lasting improvement.

Is this procedure for me?

Dr. Gilbert Lee is a board certified plastic surgeon at Changes Plastic Surgery & Spa in San Diego, CA.  Let him turn your frown upside down.  Contact Changes Plastic Surgery & Spa for analysis and recommendations.

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