As mentioned, aging changes around the mouth take different forms and at different rates. These changes vary
according to age, race, sex, history of smoking, degree of sun damage, type of skin and
familial hereditary characteristics.
The youthful mouth has the following characteristics:
- 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
The overall changes that may be seen are summarized in the following drawing:
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
TREATMENT OF THE LARGE LOWER LIP
TREATMENT OF VERTICAL LIP 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
TREATMENT OF THE “FROWNY MOUTH”
TREATMENT OF LOSS OF WHITE ROLL
TREATMENT OF LOSS OF LIP VOLUME AND BALANCE
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
last up to 9 months.
TREATMENT OF MELOLABIAL FOLDS
surgical reduction of the depressor angularis oris muscle may be used, but botox can achieve the same result, albeit on a more temporary basis.
improvement in the melolabial folds and the angle of the mouth using the lifting surgical technique together with surgical weakening of the depressor angulari soris and fat augmentation of the mesolabial folds.
Surgical markings for angular lift and weakening of the depressor angularis oris muscle.
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
TREATMENT OF CHIN PORES
TREATMENT OF THE QUIVERING CHIN
TREATMENT OF JOWLS
TREATMENT OF PRE-JOWL SULCUS
makes photographs much more pleasing!
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With a 3-D procedure, there are several layer of sutures, accurately placed to give the lifting, tightening and filling, without leaving any tell-tale pull-lines. Some are slow dissolving sutures, others are more permanent. The skin sutures are generally removed between 7 and 14 days.
Bleeding is not common as we pay close attention to proper hemostasis. On rare occasions, a small hematoma may collect.
Everyone will experience some numbness in the face: this resolves over weeks to months. This occurs because of the dissection of the face. This is not a complication.
Because of the dissection and repositioning of the tissues, it is common for there to be small differences in the smile between the right and left sides: this is usually only noticeable to the patient and to Dr. Patel! It recovers over a few weeks.
All faces have asymmetry and there will be some degree of asymmetry. This is to be expected.
Permanent weakness of nerves and muscles is rare.
The scars are usually very well hidden. However, some patients may have a tendency to cause hypertrophic scarring: in such cases, certain lasers and treatments will help. By-and-large, scars are rarely a problem. With Caucasian skin, pinkness of scars is to be expected for several weeks. With darker skin, some hyperpigmentation may occur.
In the first few days, everyone will experience some degree of dryness and blurry vision. You will also feel that your lids look a little tight on the outer corner where you will also feel some of the deeper sutures if you put your finger there: this is of no concern. The tightness and the bumps under the skin settle over a few weeks.
More serious complications which are very rare include excessive bleeding, hemorrhage and loss of vision.
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CONTACT DR. PATEL
Do you have questions or need more answers?
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