One of the more current areas of rejuvenation in facial plastic surgery today is the cosmetic enhancement of the lip and perioral (mouth) area. We typically find that patients complain about one of three challenges with their lips. They are either wrinkled, too thin or the upper lip is too long. Heredity can often contribute to a thin upper lip and even a thin lower lip. Additionally, it is very common to develop vertical wrinkles of the upper lip and areas around the mouth which can accentuate the aging appearance. The aging process can also contribute to an elongated upper lip. The good news is that all of these can be corrected.
Patients who have thin upper lips often want a fuller, more “pouty” look. We can enhance the shape of thin lips by utilizing injectible fillers with or without lip vermillion advancement and shortening the elongated upper lip with a lip lift.
The only subtle and safe injectible filler to enhance the volume of the lips are hyaluronic acid gels. Although they are not permanent, they last 6-8 months and give a very natural appearance.
Patients who want to have permanently larger lips (the pink portion) can undergo a surgical procedure called lip advancement. This procedure involves removing a small strip of skin above the border of the pink portion of the lip and advancing the pink portion upward and outward to create a fuller effect. This is commonly done for the lower lip vermillion if the upper lip vermillion is advanced. The “Cupid’s bow” (the lip’s double curve) can be treated or enhanced at the same time.
Long Upper Lip
For patients who feel that their lips are too long or want to shorten them, a lip lift may be the preferred procedure. During a lip lift (subnasal lift), skin at the base of the nose is removed and the upper lip is shortened, and the lip is rolled out – giving more “show”. There is a thin healing line hidden at the base of the nose. A lip lift is a very effective procedure and can be done in conjunction with a lower lip advancement and injectible filler for more volume enhancement.
Aging women often experience lipstick “bleeding” – which is caused by fine and/or deep lip wrinkling. A variety of procedures can be used to correct this condition.
- Injectible fillers such as hyaluronic acid at the lip borders divert into the deeper vertical grooves to minimize the appearance of the wrinkles.
- Resurfacing treatments can provide a much more definitive and permanent treatment of lip wrinkles. This is usually done utilizing a resurfacing technique that requires anesthesia: dermabrasion, chemical peel or laser resurfacing. Although the healing time is a week to 10 days before make-up can be applied, the results are fairly immediate and dramatic. Once the wrinkles are removed with a resurfacing technique, they will take many years to form again. It is fairly common for a few of the deeper wrinkles to partially remain after one treatment, and touch-up procedures may be performed to further enhance the results.
- I also perform a procedure called the “corner-of-the-mouth lift”. This procedure is beneficial for patients who have hereditary and aging tendencies for a downward turn to the corner of the mouth, giving them a frowning or scowling appearance. Usually, the candidates for this procedure have already undergone a facelift for lifting the jowl tissues and sagging skin along the jawline. The first and most common treatment for damage around the corner of the mouth, oral commissure grooves and marionette lines is to utilize an injectible filler. However, for the more severe cases, the surgical procedure of lifting the corner of the mouth may provide the best result.
Patients may have previously had procedures to remove wrinkles around the mouth. Still, they may complain that the groove between the corner of the mouth and the chin tends to become deeper, which gives them an aging appearance. Not everyone is a candidate for this procedure; however, for patients having the proper skin type and the potential for adverse scarring, a corner-of-the-mouth lift may be an ideal procedure to permanently lift the corner of the mouth and rejuvenate the perioral area satisfactorily.
Because there are so many options from which to choose for enhancing and fixing the lip area, the consultation with Dr. Perkins is very beneficial. During this appointment, he will discuss individual issues and desired outcomes and together with the patient choose which procedure makes the most sense for each individual.