Have you heard the expression, "Down in the mouth?" Do people ever come up to you and ask, "Why do you look sad?"
Even though you might feel perfectly content, when people keep asking if you're sad or angry, it could leave you feeling ... well, sad or angry.
Many people can't help projecting a sad or angry appearance, even when they're not feeling that way. It's a matter of DNA. Some people inherit stronger muscles, called the depressor angularis oris, which turn the corners of the mouth downward.
You can reverse this expression by smiling continuously, which isn't practical, and might even border on inappropriate in the wrong context. (Remember the notorious Joker from Batman?)
So, while smiling is a wonderful thing, you can't do it all the time to rectify this issue.
Fillers such as Restylane, Juvéderm or Sculptra can help turn the corners of the mouth upward. Note that I said "help," but not correct entirely.
If fillers can't adequately address the problem, you might need minor surgery to elevate the corners of the mouth. This involves removing a small triangle of skin just above the corners of the lips, and this elevates the area permanently.
The procedure is performed under local anesthesia and leaves a faint scar. The choice then becomes whether you want to trade a chronic "down in the mouth" look for a small scar above the lip.
An added benefit is this procedure can reduce the "marionette" lines significantly. Another effective, non-surgical, but temporary treatment is Botox or Dysport injected into the muscle below the corner of the mouth.
Weighing these options is an expected part of what each patient should consider during the decision-making process for any type of surgery.
Other anatomical features that make us look unhappy, angry or sad are the frown lines between the brows. This expression is caused by the corrugator muscles, which become stronger as we grow older and are caused by frowning and squinting.
We all have a reason to scowl at times, but too much frowning strengthens the muscle and deepens the lines to the point that they contract even when we are happy. As with any muscle - when you exercise it, it becomes stronger.
There's a simple solution for treating frown lines - Botox or Dysport. If you continue to receive these injections, the muscle becomes weaker and the lines become less pronounced.
Using filler is also an option to help elevate the wrinkles as well. This must be done very carefully to avoid more sagging.
For truly deep wrinkles, the muscle can be surgically removed. For a saggy outer brow causing a sad look, a brow lift can be performed along with removing the muscles that make you frown.
So, if your outward appearance doesn't match your feelings on the inside, the solution might be easier than you think.
And that's something to smile about.
E. Ronald Finger, MD, FACS is a board certified plastic surgeon with offices in Savannah and Bluffton. www.fingerand associates.com