Rejuvenation of the Aging Mouth
Dr. Gordon H. Sasaki, M.D., F.A.C.S.
An "old mouth" is a telltale sign of the aging face. The upper lip lengthens and sags, the corners droop, the lip line thins, wrinkles appear and lipstick migrates off the lips. As the mouth undergoes a "set' look, the lip loses volume and its natural turned-up pout. The lower lip also thins and develops a horizontal groove called the "old folk's gully." The nasolabial line deepens into a furrow and the "marionette lines" turn down and suggest an attitude of bitterness.
In the past, the options to rejuvenate the mouth area have been few. Resurfacing techniques of dermabrasion, chemical peels or laser have improved only the wrinkling, a small aspect of the mouth's aging process. Filling methods to smooth out the lip lines are temporary. Face and neck lift procedures do not address the aging mouth.
The mouth requires a direct surgical approach to achieve a more youthful look. The resulting small scars are an acceptable trade-off for a happier, upturned mouth.
WHO ARE CANDIDATES?
The appropriate candidate is any patient who seeks to improve as many of these changes as possible by converting the "down and thin" of age to the 'up and full" of a more youthful appearance. Some of these patients may present with these findings after a face-lift, or resurfacing/filling treatment to the perioral region. Patents with deeper skin pigmentation or patients who form scars may not be ideal candidates for small incisional scars around the mouth.
HOW ARE THESE PROCEDURES PERFORMED?
THE UPPER LIP LIFT
A lip lift is performed to shorten the long lip of aging, allowing the upper teeth to show slightly when the lips are slightly parted. It turns up the upper lip creating a fuller appearance. A wavy ellipse of skin under the nose-lip junction is removed (average 5-7 mm). Adding a vertical skin excision to the lip lift narrows the wide lip and sharpens the V of the cupid's bow.
THE CORNER LIFT
The corner lift is performed to elevate the down turned corners of the mouth that shifts the appearance from unhappy to perky. Removal of a small triangle of skin above each corner (5-7mm) elevates the corner. The final white scar is difficult to see and lies along the lip border, extending outside the corner about 5mm.
THE UPPER AND LOWER LIP ADVANCEMENT
Lip advancement is performed to expose more of the pink lip mucosa and to remove some of the vertical lip lines. A small strip of skin outside the lip line is removed to re-establish the pout to the upper and lower lips.
Lip advancement is performed to expose more of the pink lip mucosa and to remove some of the vertical lip lines. A small strip of skin outside the lip line is removed to re-establish the pout to the upper and lower lips. This technique does not create fuller lips. To achieve fuller lips, your own tissue or donor tissue would need to be added.
REMOVAL OF “PUFFS”
The “parachute” area of loose folds adjacent to the corners of the mouth are difficult to improve by face-lift procedures. A direct excision of loose skin and fat in the lower portion of the nasolabial fold and upper portion of the “marionette” folds can improve this area of tissue redundancy. The scars become less noticeable with time, but may require microdermabrasion or scar revisions to smooth out irregularities.
ARE THERE ANY SIDE EFFECTS?
Direct excision of skin in the visible perioral area usually heal well with an acceptable trade-off scar for the cosmetic defect. This may mean that scars are barely visisble at a conversational distance or beyond.. Occasionally, scar revisions or smoothing out of the irregular scars by dermabrasion, or microdermabrasion my be necessary. Scars progress from a red to a white color over a period of a year. Cosmetic make-up may be applied once the sutures are removed. Pigmentary change (darker or lighter) can be treated with blending agents and sunscreen blockers to obtain matching of skin tones.
WHAT KIND OF RESULT CAN I EXPECT?
An improvement of the perioral signs of aging is expected. These changes are permanent and natural. However, because skin tends to become lax with progressive aging, minor touch-up tightening procedures may be required at a later time.