title: Surgical correction of the frowning mouth.
abstract: BACKGROUND
  The available perioral rejuvenation procedures only partially correct the frowning mouth deformity, which is composed of sagging of the oral commissures and frequently associated with marionette folds. The authors describe their method of surgical correction for this condition and offer a classification for frowning mouth deformity.
  
  
  METHODS
  Twenty-seven patients underwent correction for frowning mouth deformity from 2000 to 2009. The deformities and the corresponding methods of correction were divided into two types. In type I frowning mouth deformity, correction was performed by lentiform excisions at the vermilion border, and in type II deformity, lentiform excisions also included the marionette folds.
  
  
  RESULTS
  Correction of frowning mouth deformities, either as an isolated procedure or concurrent with face lift, was satisfactorily achieved in all 27 patients. All patients were followed for a minimum of 3 months, and 88.9 percent were followed for 1 year; 18.8 percent of the patients showed erythema and scar hypertrophy at the sites of marionette fold excision during the early postoperative period. However, all scars improved over time, with high patient satisfaction.
  
  
  CONCLUSIONS
  Frowning mouth deformities are correctable by excising lentiform segments of skin through incisions placed at the vermilion border that may be extended to include the marionette folds. Proper patient selection and counseling, particularly regarding temporary or possibly permanent noticeable scar formation, is of utmost importance. When such measures are taken, the outcome is good and patient satisfaction is high.
authors.affiliation: Honolulu, Hawaii From the Department of Surgery, University of Hawaii, John A. Burns School of Medicine.
authors.forename: Fereydoun Don
authors.initials: FD
authors.lastname: Parsa
authors.forename: Natalie N
authors.initials: NN
authors.lastname: Parsa
authors.forename: Daniel
authors.initials: D
authors.lastname: Murariu
mesh_terms: D000368:Aged; D000375:Aging / Q000473:pathology*; D003358:Cosmetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000473:pathology* / Q000601:surgery*; D017060:Patient Satisfaction; D012060:Rejuvenation; D015361:Rhytidoplasty; D013518:Surgery, Plastic; D011795:Surveys and Questionnaires
chemical_list: D003358:Cosmetics