Help for people who feel happy when face indicates otherwise

By E. Ronald Finger CONTRIBUTOR

For many people, their outward appearance doesn’t seem to match their demeanor nor their feelings. Happy people sometimes look sad or angry because of natural lines and facial muscles.

A common complaint of patients is they can’t help projecting a sad or angry appearance, even when they are not feeling this way. It might be a matter of DNA.

Some people inherit stronger muscles, called the depressor angularis oris, which pull the corners of the mouth downward. One can reverse this expression by smiling continuously, which isn’t practical and even inappropriate in the wrong situation.

Remember Jack Nicholson as the notorious Joker from “Batman”? So, while smiling is a wonderful thing, doing it all the time may look a little strange.

An effective non-surgical, but temporary treatment is Botox, Dysport, or Daxy (which lasts twice as long) injected into the muscle below the corner of the mouth, allowing the corner to move upward. Fillers such as Restylane and Juvederm can also help turn the corners of the mouth upward slightly.

Alternatively, PDO threads might do a better job of both lifting and stimulating your own elastin, improving skin elasticity. Threads can be inserted in a few minutes during an office visit.

Ultimately, some patients may need minor surgery to elevate the corners of the mouth. This involves removing a small triangle of skin above the corners of the lips, elevating the area permanently but naturally.

The procedure is performed under local anesthesia and leaves a faint scar. The choice becomes whether you want to trade a “down in the mouth” look for a small inconspicuous scar above the outer part of the lip. An added benefit: This procedure can reduce the “marionette” lines between the corners of the mouth to the jawline.

Another feature that makes one look unhappy, angry or sad are the frown lines between the brows. This expression is due to the corrugator muscles, which become stronger as we grow older and is caused by frowning and squinting. We all have a reason to scowl at times, but too much frowning strengthens the muscle and deepens the frown lines – often called “the elevens.”

There’s a simple solution for treating frown lines – Botox, Dysport, or Daxy injections. If you keep up with these products, the muscle becomes weaker, the lines become less pronounced, and you can inject them less frequently.

Using a filler is also an option to help elevate the wrinkles as well. A better, more permanent treatment is using PDO threads, which stimulate collagen and elastin production filling and smoothing the wrinkles. The threads last about six months, but the effects of PDO threads usually last 18 months to two years. PDO threads can also lift the face, brow and neck non-surgically. So, if your outward appearance doesn’t match your inside feelings, 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. fingerandassociates. com