aging of the mouth
nasolabial folds, melolabial folds, lips
HOW DOES THE MOUTH AREA AGE?
HERE IS THE APPEARANCE OF A YOUTHFUL MOUTH IN A MALE AND A FEMALE
“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 63 Yrs Old with Fat Droopy Eyes – Salt Lake City, UT
HERE ARE SOME OF THE AGING CHANGES SEEN IN THE AREA OF THE MOUTH
NASOLABIAL FOLDS: LINES FROM YOUR NOSE TO YOUR MOUTH
Nasolabial grooves or folds are the lines that extend from just to the outside of the nasal alar to the side of the mouth: they can give the look of “parentheses”, which can give one a glum or sad look. The deeper they are, the more the shadow cast below the fullness above, making the face look older. They generally gradually worsen after the mid-30’s in most people. Certain races like the Greeks and the Arabs have a tendency to develop pronounced nasolabial and melolabial folds.
Fillers such as restylane and juvederm may be used in these folds: these fillers last about six months. Radiesse is a material that lasts nine months and is particularly useful in this region.
Nasolabial folds can also be lifted and filled with injections of Sculptra. Sculptra is a newer and longer-lasting treatment than Restylane or Juvéderm. Sculptra stimulates collagen growth deep in the skin. You may want to start with Restylane or Juvéderm to make sure you like the effect on your nasolabial folds before committing to something that lasts 1-2 years. Sculptra is usually injected as a series of two to three treatments administered every four to six weeks. Subsequently, patients may need one injection a year to maintain the results.
MELOLABIAL FOLDS: LINES FROM YOUR MOUTH TO YOUR CHIN
The downward sloping grooves from the corners of the mouth to the chin make the lower part of the face look older for several reasons. The corners of the mouth look like they are pulling downwards, again giving one a sad look. Furthermore, fullness lateral to these folds exacerbates the jowls that inevitably develop along the jawline and can give one a squarer lower facial shape, which is not pleasing in female faces. In men, it gives them an “hang-dog” look.
To some extent, these melolabial folds may be helped with similar fillers to the ones discussed above. However, in more pronounced folds, surgery is the only option.
WHY NOT USE PERMANENT FILLERS FOR NASOLABIAL AND MELOLABIAL FOLDS?
Permanent fillers include Artefill and silicone. The risks of using permanent fillers far outweigh the benefits. In particular, any side-effects that occur may be permanent. Furthermore, if the permanent fillers need to be removed, they have to be removed surgically with marked residual scarring. Finally, allergic reactions to some of these materials may show up some years after the injections are administered. There are no solutions available that may be
used to dissolve these permanent materials.
Also, one must not forget the face continues to “move” as we age: fillers may look good when placed at a certain area when a patient is in the 50’s. However, with age, the soft tissues collapse, absorb and descend. Also, people’s weight changes: all these changes can make the filler look worse over time.
CAN YOU COMPLETELY ERADICATE MY NASOLABIAL FOLDS WITH FILLERS?
I can but I won’t. Even babies (and children and young adults) have a gentle groove from the nose to the mouth: this gives shape, angles and shadows to the face which is what makes a face look inviting or pleasing. Completely eradicating the folds flattens the face and takes away the pleasing angles and shadows one normally associates with good-looking faces.
WHAT CAN I EXPECT AFTER RECEIVING FILLERS IN MY NASOLABIAL AND MELOLABIAL FOLDS?
The filler may be palpable for the first few days but will not be visible. Over a few days, fluid gets absorbed by the hyaluronic acid fillers and the hydroxyapatite fillers (Radiesse): thereafter, the fillers are not palpable. Once settled, the face will look rested, refreshed and natural. It is always wise to be conservative with fillers: one
can always inject more if needed.
DIFFERENT PARTS OF THE FACE WHERE FILLERS MAY BE USED
Children tend to have those wonderfully natural plump lips. The lips of some movie stars, like Angelina Jolie, have acquired iconic status. What are your options to get fuller lips?
Juvéderm/Restylane for lips are excellent options for a lip enhancement. One can get immediate results with maintenance approximately once every six months. Juvedera nd restylane both work well but Juvederm is more useful if one wants less puffiness after the injections. However, as far as results go, both work very well indeed. Always start conservatively and, as we discuss in the section under lips, always have injections done by someone who knows the anatomy and physiology of this region. It is important to create proper proportions when using fillers in the lips. Sometimes, very substantial improvements may be obtained if fillers are used propery and in the appropriate ratios.
UPPER LIP LINES AND LIP BORDERS
Lips, in youth, have a fullness as well as distinct structures: the pink part of the lip goes on to the white roll which then gives way to the smooth skin of the areas above and below the lips. These edges become fuzzy with age and the pink part of the lips bleeds into the skin of the mouth, so that when lipstick is applied, it tends to bleed into these lines. The skin above and below the lips loses collagen (more rapidly in smokers and sun-worshipers), and develops vertical lip lines, Certain races (the northern European Scandinavian races in particular), are prone to develop lines earlier than in pigmented races. The upper and lower lip lines are more pronounced when we purse the lips. They are often called “smokers’ lines” even in non-smokers. They are sometimes termed marionette lines, but this term of marionette lines should really be reserved for the lines that go from the corner of the mouth to the chin: the melolabial folds.
I HATE THESE LIP LINES: GET RID OF THEM!
A number of factors have to be taken into account when deciding how to best treat these lip lines. There are several modalities that are used in combination to get the very best results. For example, we often combine the use of the CO2 laser with fillers and even dermabrasion to achieve the best result. In some patients, the CO2 laser is repeated six to nine months later to avoid the formation of a demarcation line. Fillers are generally injected to give the lips shape but can also be used to soften vertical lines.
Botox is only rarely used and when it is used, it is injected in micro-doses to avoid paralyzing the mouth muscles. However, a small amount of botox wil help reduce the lines, but only for a few months.
We often use additional lasers when treating lip lines to heat the deeper tissues and allow new collagen to form: the results improve over time and the collagen builds up deep to the wrinkles.
Chemical peels may be used in some instances, but peels will only help more superificail lines.
These days we use fractional CO2 and Erbium laser: these allow the formation of new collagen without giving you demarcation lines. These lasers are repeated after six or so months. Redness, swelling and oozing will occur for two to three days: the pinkness can generally be camouflaged by day five to six. These lasers also allow us to make the vermillion border mor sharp and distinct.
Marionette lines are lines or grooves that run from the corners of your mouth down to the bottom of your chin. They can give your lower face a slightly saggy look, or make the corners of the mouth look frowny or downturned.
A number of different fillers work well to improve the appearance of Marionette lines: juvederm, restylane, perlane, radiesse and others. The correct type of filler is chosen to give you the best result: the choice will depend upon your age, the depth of the grooves, the state of the surrounding structures and the desired outcome. Most fillers in these grooves will last between six andnine months. If the lines are deep, you will need one vial on each side.
Sculptra treatments to fill the cheeks will help to lift the skin that is sagging along the jaw line and creating these marionette’s lines. Sculptra is expensive. You will need two to three treatments approximately 4 to 8 weeks apart at a cost of $1,000 to $2,000 per treatment. One maintenance treatment a year is usual, and longevity is one of Sculptra’s strengths.
Sculptra also takes from 4 to 9 months to add volume and thus lift the sagging skin at the jaw line. If you can afford it, Thermage plus Sculptra may be the best way to tighten skin all over the face, and help reduce these marionette’s lines.
DROOPING AT THE CORNERS OF YOUR MOUTH
The downward turn to the corner of the mouth can make us look sad: this change is inevitable with time because of gravity and also because of the anatomical changes that occur in the peri-oral muscles. Support to the skin structures is lost as is deeper facial fat. The muscles also age and no longer have the fullness of youth.
Fillers like juevederm and reatylane give nice results. We usually combine these fillers with botulinum toxin into the depressor angularis oris muscle, which is the muscle which olds the corner of the mouth down.
MAKING YOUR LIPS SMOOTH
Sun damage and aging can both make our lips drier and more wrinkly. Be sure to use lipstick with sunscreen.
You might want to try Bobbi Brown SPF 15.
You should also use a lip moisturizer and, if your lips are very dry and wrinkly, try an antioxidant lip cream. Peels can also help keep your lips smooth. And adding some volume to your lips with Restylane or Juvederm often makes the lips look rehydrated.
“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.” D. Gull Highly recommended for eye lift surgery – Salt Lake City, UT
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Dr. BCK Patel MD, FRCS
Salt Lake City, Utah 84106, USA
(801) 413-3599 (phone/text)
Dr. BCK Patel MD, FRCS
617 E Riverside Dr Suite 101
Saint George, UT 84790, USA