Mouth
In normal conversation, we look from eye-to-eye and then to lips. Next to eyelids, most people notice aging changes that affect the lips and the perioral region the most.
- The distance from the nose to the upper lid margin is short, about one half of the distance between the lower lip and the chin.
- Smooth upper and lower lips with no vertical lines
- Pronounced cupid’s bow and vertical philtral columns and and an inter-column depression
- Distinct white roll
- Good lip volume with a balance whereby the lower lip is roughly twice as full as the upper lip
- Gentle nasolabial folds with a smooth transition from the perioral region to the cheeks
- Lack of Marionette lines with horizontal or slightly upward slant to the lateral commisures
- Pronounced chin with no ptosis of the chin fat pad
- Smooth chin with no visible pores
- No visible quivering of the mentalis muscle
- A smooth jawline with a lack of jowls or pronounced depressions
63 Yrs Old with Fat Droopy Eyes
Salt Lake City, UT
Well, the last time I had a picture taken I could hardly see my eyes because of the weight of heavy eyelid. Then I paid attention to how I was actually using my eyes and I really noticed when I was looking at anything especially the computer I was straining my forehead to see better. Since I have had it done I no longer have to lift the forehead and tilt my head to see. It is amazing! I love…
D. Rock
The overall changes that may be seen are summarized in the following drawing:
- Elongated upper lip
- Lip vertical lines
- Loss of cupid’s bow and vertical columns
- Loss of white roll
- Loss of lip volume and loss of balance
- Nasolabial folds
- Melolabial folds (Marionette lines)
- Witch’s chin
- Large pores chin
- Quivering chin!
- Jowls
- Pre-jowl sulcus or hollow
Treatment of the elongated upper lip
As we age, the distance between the nose and the upper lip elongates. When significant, this distance can be narrowed using a “bull-horn” technique where radiofrequency instruments are used to give an almost invisible scar. Tissue removed can be de-epithelialized and used to augment the upper and/or lower lip as well.
Treatment of the short upper lip
If the upper lip is too short, there is an appearance of “teeth-show”. In such cases, the frenulum which is too short is lengthened with multipls Z-plasties.
Treatment of the large lower lip
Macrocheily is an excessively enlarged lip: it is seen in a number of conditions. These large lips are reduced with an anatomically planned resection of a longitudinal wedge of mucous membrane deep inside the lower lip so that the subsequent scar is well hidden.
I had lines around my mouth because I was a smoker. I hated the way the lines looked old and puckered. I was looking like my mother! I could see the lines in photographs. My aesthetician was amazed at the result of the laser treatment Dr. BCK Patel did for me. My lines are gone and no-one can tell I had them. My aesthetician showed me a photo she had taken before which showed my lines and I was amazed. I wish I had had these treated a long time ago as I love the way my lips look now.
H. T
Treatment of vertical lip lines
The eyelids and lips are unique in that there are muscles which have no deep attachment to the periosteum but only attachments to the cutaneous structures. This results in vertical lines around the lips and crows’feet around the eyes. The vertical upper and lower lip lines are variously called “lemon wrinkles”, “smokers’ lines”, and “bleed lines”.
Lip lines can be treated using several techniques, each chosen with the patient’s skin type, age and pigmentation in mind. Dermabrasion, chemical peels, radiofrequency peels, laser peels and other methods are available to treat these.
Treatment of loss of cupid’s bow and vertical columns
Suture and incision techniques now allow us to obtain subtle but impressive elevation of the cupid’s bow and some accentuation of the philtral columns. These are minimally invasive techniques which yield a reliable outcome. This particular technique is called philtropexy.
Treatment of the “frowny mouth”
A frowny mouth is the term used to describe the down-turning corners of the mouth or lip commissures. This downward turn gives the face a sad, pessimistic facial expression. Even with well-performed facelifts, this downward angulation of the lip commissures can be difficult to correct.Using “Optimistic suture” that were designed by Dr. Panfilov, we have had excellent results. This correction may be performed at the same time as a facelift or in isolation.
Treatment of loss of white roll
There is a clear reflection of lips just above the pink edge of the lips called the vermillion border. This “white roll” is lost with age, as we lose the definition between the upper lip and the vermillion border. Together with this loss of the white roll, we also lose the vertical columns called the philtral collumns. In youthful lips and mouths, these philtral columns are separated by a hollow, the inter-philtral groove, which gives the upper lip and the area between the nose and the upper lip structure. Caucasian races lose these structures (the white roll, the philtral columns, the inter-philtral groove) earlier than other races. Even without surgery, with the proper use of fillers of various kinds, one can recreate these youthful anatomical landmarks as seen here.
Treatment of loss of lip volume and balance
The balance of the upper and lower lips has to be remembered but differences between countries should also be considered. For example, in Brazil, the upper and lower lips are balanced equally. In most of northern Europe, the creation of the cupid’s bow with philtral columns and a larger lower lip is considered more attractive.
Microlipofilling of facial structures with autologous fat grafts can be used for different parts of the face, including the upper and lower lips. Variable amounts of properly treated fat are injected into the upper and lower lips. There is always postoperative swelling which can make the augmentation look excessive, but this invariably settles to a level where one wishes more had been done! There is a variable degree of absorption of the transplanted fat, but as I always tell my patients, the 50 – 60% that survives is forever (almost)!Other options of augmenting lips include fillers which are presented and discussed elsewhere. We also use the SMAS we remove during facelift surgery to augment parts of the face, including lips as needed.
Other options of lip augmentation include the use of orbicularis muscle removed from eyelids, temporalis fascia or other fascia or muscle, depending upon what other surgery may be performed. Fascial and muscle graft absorption is about 50%.
Treatment of Nasolabial folds
Nasolabial folds are the folds one develops between the nose and the mouth. These folds deepen with age and make the midface look older, casting a shadow below the cheek. There are several approaches to improving nasolabial folds. Non-surgical approaches include the use of fillers which may be performed in clinic and will give results that last up to 9 months
Treatment of melolabial folds
Melolabial folds are the folds between the corners of the mouth to the jawline: these give us what we call “frowny faces” with the downturning of the corners of the mouth. This area is treated using three techniques. Botox can be injected in the depressor angularis oris muscle which allows the depressor of the corner of the mouth to relax, hence giving us a “happier” look. A similar result can also be obtained by surgically weakening the depressor angularis oris and elevating the angles of the mouth with proper plastic surgery techniques:
Fillers can be used in the melolabial folds and along the jawline to improve the shadows cast by the deep
melolabial folds and the area in front of the jowl.
Treatment of the witch’s chin
The witch’s chin is the description used for the droop in the chin that occurs with age. In the lateral view, it shows as a “dropped chin”, with the inferior edge of the chin extending below the neck line, giving the so-called witch’s chin. We always address this when we perform facelifts and necklifts to improve the profile view of the face and neck:
Treatment of Chin pores
The skin around the mouth and chin ages much more than the skin on the rest of the face because it is made up of thicker, more sebaceous skin and also because of the constant wear-and-tear that this area undergoes. Indeed, changes like a deep crease just below the lower lip, pores on the chin, quivering of the chin muscles (the mentalis muscles), vertical lip lines, nasolabial folds, melolabial folds, jowls, and lengthening of the upper lip all conspire to give us an older look. In plastic surgery, when we perform facelifts and necklifts, we address each of these changes to give the rest of the face a nice balanced result. Some of these changes can be addressed with fillers, botox and lasers.
Treatment of the quivering chin
As we age, the mentalis muscle often develops a quiver which gives us depressions on the chin. This change can be nicely managed with the use of botox injections. If there are any depressions, fillers or fat grafts improve the changes without resorting to the use of chin implants, which are reserved for the genuinely recessed chin (hypoplastic chin).
Treatment of jowls
The best treatment for jowls is a properly performed facelift and necklift. This allows the creation of a strong jawline, the reduction of jowls and the recreation of a youthful face and neck. Isolated liposuction of the jowls does not give reliable or effective results.
Treatment of pre-jowl sulcus
On occasion, when a patient does not desire to undergo surgery, the hollow in front of the jowl can be partially filled with a filler which gives a straighter jawline. Although the results are not as good as seen with a well-performed facelift and necklift, they are still excellent. In particular, when photographs are taken, these pre-jowl hollows (sulci) cast a shadow which makes people remark “I don’t like my photos to be taken”. Improving this jawline
makes photographs much more pleasing!
Highly recommended for eye lift surgery
Salt Lake City, UT
I had a excellent eye lift done by Dr. Patel. He knows what he is doing and is very pleasant. Dr.Patel was easy to get an appointment and he works with you. The office staff was very pleasant and made you feel calm.
