One of the more current areas of rejuvenation in facial plastic surgery today is the cosmetic enhancement of the lip and perioral (around the mouth) area. We typically find that patients complain about one of three challenges with their lips. They are either wrinkled with vertical lines of the upper lip, too thin or the upper lip is too long. The lip often becomes elongating as a person gets older. Heredity can contribute to a thin upper lip, even in a younger person. This can also be true of the lower lip being thin, but usually age causes thinning of the lower lip. It is also very common to develop vertical wrinkles of the upper lip and areas around the mouth which can accentuate the overall aging appearance of the face. The aging process can also contribute to an elongated upper lip. The good news is that all of these can be corrected.
Aging women often experience lipstick “bleeding” – which is caused by fine and/or deeper lip wrinkles. A variety of procedures can be used to correct this condition.
Injectable fillers such as hyaluronic acids at the lip borders can fill 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. For persistent visibility of vertical wrinkles of the upper lip and for lipstick “bleeding”, other techniques can be used, such as chemical peel, laser resurfacing, and even dermabrasion or “sanding” the surface of the skin to resurface the area and smooth it out more permanently.
This is usually done utilizing a resurfacing technique that requires anesthesia: dermabrasion is one technique, but also chemical peel or laser resurfacing can be used to smooth out the wrinkled collagen under the surface of the skin of the upper lip. Women seem to experience this more than men due to the fact that men may have beards. It is often thought to be caused by smoking, but we all purse our lips just when talking. The continuous motion of the upper lip in that fashion, along with the loss of elasticity, creates vertical lines.
Dermabrasion is used on top of or in conjunction with laser resurfacing where a deeper layer of treatment is indicated, i.e., for very etched in or deep vertical lines of the upper lip. Dr. Perkins commonly performs carbon dioxide and erbium laser resurfacing for fine and medium wrinkling of the upper and lower lips, whereas dermabrasion is usually required for deeper etched lines of the upper lip, lower lip vermilion and perioral region.
Resurfacing is a more involved procedure, taking nearly 1 ½ weeks to heal before make-up can be applied. However, the results are fairly immediate and quite dramatic. The new skin is quite pink and red for a while but it does fade. This more permanently removes the wrinkles as the collagen is tightened under the surface of the newly healed surface skin. Once the wrinkles are removed with the 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.
Patients who have thin upper lips often want a fuller, more “pouty” look. We can enhance the shape of thin lips by utilizing injectable fillers, with or without lip vermillion advancement, and shortening the elongated upper lip with a lip lift.
The only subtle and safe injectable fillers to enhance the volume of the lips are hyaluronic acid gels. Although they are not permanent, they last 6-9 months and give a very natural appearance – when properly done.
Patients who want to have permanently larger lips (with more show of 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 or more visible effect. This is more commonly done for the lower lip by taking a small strip of skin underneath the vermillion, or the pink portion of the lip, and rolling it downward or outward. For the upper lip, one has to make sure the “Cupid’s bow” (the lip’s double curve) can be maintained or highlighted at the same time. These procedures are called upper and lower lip advancement or vermilion advancement.
The reason it is not as commonly used for the upper lip is that, if one has a pout or roll to the border of the upper lip that has not diminished with age and time, a lip lift is a more common procedure to maintain this.
Long Upper Lip
For patients who are losing the “show” of the upper lip vermilion, a lip lift may be the preferred procedure. During a lip lift (subnasal lip lift), a portion of the skin at the base of the nose is removed and the upper lip is shortened, and the lip is then rolled upward and outward – giving more “show”. There is a thin healing line hidden in the contours of 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 injectable filler, if desired for more volume enhancement. Again, a subnasal lip lift is the most common procedure performed to surgically rejuvenate the upper lip. This can be done for younger patients as well as the more aging patient, particularly if heredity has not given the more youthful patient much vermilion show.
Downward Turn of the Corner of the Mouth or Frowning Appearance
Dr. Perkins also performs a procedure called “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. Often, the candidates for this procedure have already undergone a facelift for lifting the jowls and sagging cheek tissues. This helps somewhat but because the facelift procedure is also done in a very natural way, it does not pull the corners of the mouth at all so as not to give one an unnatural appearance. The groove that occurs from the corner of the mouth down to the chin is improved but the corner of the mouth still has a downward groove. The first and most common treatment for the creasing and grooving around the corner of the mouth, oral commissure grooves and marionette lines is to utilize an injectable filler. Again, hyaluronic acid is the most common filler that does fill these areas to a significant degree, but it does not completely correct the downward turn. It is also not permanent, even though it may last well over 6 months to a year. For the more severe cases and ones that are persistent despite the filler, 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 or a frowning look. Not everyone is a candidate for this procedure; however, for patients having the proper skin type and minimal 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 even more.
Because there are so many options from which to choose for enhancing and fixing the perioral or lip area, the consultation with Dr. Perkins is very beneficial. During this appointment, he will discuss your individual issues and desired outcomes and together, he will help you make a decision as to which procedure makes the most sense.