The Happy Face Treatment: An Anatomical-Based Technique for the Correction of Marionette Lines and the Oral Commissures

November 2018 | Volume 17 | Issue 11 | Original Article | 1226 | Copyright © 2018

Frank Rosengaus-Leizgold MD,a Elizabeth Jasso-Ramírez MD,bNathania Cárdenas Sicilia MDa

aFacial Plastic Surgery, Ultimate Medica, México City, México bFacial Plastic Surgery, ENT Department, Angeles Lomas Hospital, México City, México

Abstract

When viewing the most famous smiles in history (Figure 1), two constants become apparent: a smooth perioral surface and oral commissures that are turned upward (or horizontal as a minimum). Patients are often fixated on improving both the marionette lines and the downward oral commissures as these distractions are one of the most noticeable areas in the aging face to the average person. In addition, the downward turn of the oral commissures gives an impression of sadness. Unfortunately, the anatomy of this area makes non-surgical treatments less than satisfactory, and unpredictable in many cases. The senior author has developed a novel technique to treat the marionette lines and turn the corner of the mouth upward that has been named the Happy Face treatment. The key for a successful outcome is the assessment of the perioral anatomy and the understanding of the physio dynamics of the jowl to produce a Mona Lisa smile and a Happy Face. J Drugs Dermatol. 2018;17(11):1226-1228.

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BACKGROUND

Individuals with early-stage melanoma experience lower melanoma-specific mortality rates compared to those with more advanced (Stage III or IV) disease. However, despite this lower mortality rate, the highest absolute number of melanoma-related deaths occur in patients initially diagnosed with Stage I or II disease.1 This is partially explained by the greater number of early-stage lesions that are diagnosed compared to more advanced cases. Recommendations for clinical management of early-stage melanoma are directed from population based risk of recurrence estimates.2,3 Patients with Stage I-IIA disease receive fewer interventions (eg, sentinel lymph node biopsy (SLNBx), use of imaging, frequency of visits) than those with Stage IIB-IIC disease. Given the magnitude of patients diagnosed with early-stage disease who develop metastases, there is a need for additional stratification tools (beyond conventional methods such as AJCC staging) that can augment identification of Stage I and II patients who are at higher risk for subsequent metastasis. A commercially available 31 gene-expression profiling (31-GEP) test (Decision Dx-Melanoma, Castle Biosciences Inc., Friendswood, TX) has been shown to be an accurate tool in identifying early-stage melanoma patients who are at higher risk for subsequent local recurrence, metastasis, or death.4-9 This validated test dichotomizes patients into lower risk (Class 1) and higher risk (Class 2) groups based on differences in recurrence and surviv

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