The lips play a very important role in overall facial attractiveness. A well defined, youthful lip is a sign of beauty. It is not surprising then that lip enhancement is so popular, even among young persons. In this age group fat injection or filler is usually all that is needed to create very desirable results. As we age the lips and surrounding soft tissues undergo changes that may not be responsive to the use of filler alone.
Correction of age related changes to the mouth is referred to as perioral rejuvenation. The perioral region includes the lips, the skin of the upper lip that extends to the base of the nose above, and the skin of the lower lip down to the inferior edge of the chin. The laugh lines and marionette lines form the outer margins of the perioral area.
In the aging face the lips thin and flatten. The upper lip elongates, and there is loss of the philthrum and the cupids bow, both hallmarks of the youthful lip. Vertical creases that extend off of the upper and lower lip, known as smokers lines, also appear. There is deepening of the nasolabial lines ( laugh lines) and marionette lines. The dynamics of lip movement also change. The vertical height of the smile shortens but the distance from corner to corner increases.
In these situations, filler alone will not give the desired result. Although other treatment modalities such as laser resurfacing, dermabrasion, chemical peels and even neurotoxin can be used alone or in combination, these approaches will not correct the significant structural changes usually found in the aging lip. In these situations surgical correction is often the best option
.The elongated upper lip can be corrected using the lip lift procedure. There are two approaches to this procedure - the sub nasal lip lift and the direct lip lift. In the subnasal approach skin is removed along the junction of the base of the nose and the lip in the configuration of a bullhorn. This allows for the incisions to be hidden. This procedure is best suited for those requiring lift over the central portion of the lip. For a flatter more elongated lip a direct lip lift is more suitable. In this procedure skin is removed along the entire length of the lip adjacent to the vermillion. This places the incision in a much more noticeable location, but in properly selected patients the results are very acceptable.
A downturned lip is not an uncommon problem. It can become much more evident in older age as the upper lip flattens and falls. The outer margins of the lip turn downward, giving the appearance of a constant frown. This problem can be corrected utilizing the "corner of the lip lift" procedure. This technique involves removing skin from along the upper outermost corner of each lip. Closure of the surgically created gap lifts the outside corner of the mouth and the incision is hidden between the corner of the mouth and the marionette line.
All of these procedures can be performed in an office setting under local anesthesia. The incisions can.take several weeks to heal, but are typically not visible once completely healed.