The lower muscular balance of the face used to lift labial commissures.

One of the weak points in face lifts is their failure to fully correct the ptosis of the labial commissures. This article illustrates a new technique to optimize this commissural repositioning in face lifts by using the muscular balances of the lower half of the face. There is, in effect, a third type of muscular balance, which acts on the commissural modiolus and is created by the opposing forces of the levator muscles (notably the zygomaticus major and the levator anguli oris) and the depressor muscles (principally the depressor anguli oris). Rarely a purely cutaneous problem, labial commissural ptosis is more a part of mediofacial ptosis affecting the entire soft tissue. I have used the malar subperiosteal face lift technique, the only approach that allows the centrofacial features to be lifted as a whole block, since late 1996 and have treated a series of more than 30 patients affected with mediofacial ptoses involving the malar eminences, the nasolabial folds, and the labial commissures. Retensioning the levator muscles was combined with wholesale subperiosteal release of the depressor muscles, notably the depressor anguli oris. Patient follow-up has lasted between 6 and 20 months. In all instances, this use of the lower facial muscular balances allowed optimal repositioning of the labial commissure. In particularly outstanding cases, unilateral release of the depressor muscles was used to correct facial asymmetry at the level of the lip commissures and thereby restore harmony and alignment. In 10 of our cases, this slackening of the depressor muscles was also used in conjunction with a peripheral face lift; the resulting heightening of the commissures was, in these cases, perhaps less spectacular, but it invariably contributed to the rejuvenation of the face.