When your expression seems down, don't worry; look happy

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E. Ronald Finger

Do people ever come up to you and ask, "Why do you look sad?" Even though you may have felt perfectly happy, when people keep asking if you're sad or angry, it could leave you feeling ... well, sad or angry.

A common complaint of patients is they can't help projecting a sad or angry appearance, even when they're not feeling this way. It's not emotion-based - 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 could reverse this expression by smiling continuously, which isn't practical, and might border on being inappropriate in the wrong situation. Remember Jack Nicholson as the notorious Joker from Batman?

While smiling is wonderful thing, doing it all the time may look a little strange.

Fillers such as Restylane, Juvederm or Sculptra can help turn the corners of the mouth upward. Note that I said "help," because they cannot correct the situation 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, elevating the area permanently but naturally.

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 inconspicuous scar above the outer part of the lip.

Weighing these options is an expected part of what each patient should consider during the decision-making process for any type of surgery. An added benefit: this procedure can reduce the marionette lines significantly.

An effective non-surgical, but temporary, treatment is Botox or Dysport injected into the muscle below the corner of the mouth allowing the corner to move upward.

Another feature that makes us look unhappy, angry or sad is 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 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. This must be done very carefully. 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, which can be done under local anesthesia..

So, if you're outward appearance doesn't match your feelings on the inside, your 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

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