Cheer up! How to have a happy face all the time

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Have you heard the expression, "down in the mouth?" Do people ever ask you, "Why do you look sad?"

Even though you might have felt perfectly content, when people keep asking if you're sad or angry, it could leave you feeling ... well, sad or angry.

For many people, they can't help projecting a sad or angry appearance, even when they're not feeling this way. It's a matter of DNA.

Some people inherit stronger muscles, called the depressor angularis oris or the DAO, 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 being inappropriate. Remember the notorious Joker from Batman?

So, while smiling is wonderful thing, you can't do it all the time to rectify this issue.

Solution? Fillers such as Restylane or Juvederm products 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, Botox or Dysport injected in the DAO can be a big help.

Or 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. This is performed under local anesthesia, leaving a faint scar.

The choice becomes whether you want to trade the "down in the mouth" look for a small scar between the corners of the lips and the smile lines. Weighing these options is part of each patient's decision-making process for any type of plastic surgery.

Other anatomical features that can 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 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 lines to the point they contract even when we are happy, resulting in permanent wrinkles, often called the "elevens." As with any muscle, when you exercise it, it becomes stronger.

There's a simple solution for treating frown lines. Botox or Dysport weakens the muscle. If you keep up with either product, the muscle weakens and the lines diminish.

Fillers are another option to help eliminate the wrinkles as well, and can be done in combination with Botox or Dysport.

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 and can be performed simultaneously with frown line correction.

So, if your outward appearance doesn't match your inner feelings, solutions are available. 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

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