One of the telltale and most bothersome signs for women as they age is the development of an aging or “old mouth”. Besides the lines and wrinkles that form in the surrounding skin, other anatomic changes occur that change its overall appearance. The upper lip begins to get longer and thinner. The drooping skin from above the lips forces the corners of the mouth to turn downward. As the corners turn downward, furrows extend from the corner of the mouth downward, known as marionette lines. The lower lip sags and the horizontal groove beneath it (labiomental sulcus) becomes more pronounced. The nasolabial folds or lip-cheek grooves, which bracket the mouth from above, become deeper.
Skin resurfacing methods, such as lasers and chemical peels, are useful to decrease wrinkling around the mouth area. But they often only improve just a part of the problem. Injectable fillers add a good method of rejuvenation because they replace lost volume and help provide a small lift to some areas of the mouth. When combined with skin resurfacing, some nice changes in the aging mouth can be seen.
In some cases, the mouth or perioral area requires some surgical manipulation to get that more youthful look. There is a set of small but very effective mouth procedures that are more effective at lifting and upturning than any injectable filler alone. The goal here is to have fuller lips with a more even or horizontal smile line. These perioral rejuvenation procedures include lifts of the lip, corner of the mouth, and smile lines.
The simplest lift is that of the upper lip. It is performed to shorten the long lip of aging, allowing the upper teeth to show slightly when the lips are slightly open. By using a wavy or bullhorn-shaped ellipse of skin under the nose, the central part of the lip is upturned. Lip advancements, however, are more widely used as they affect the entire upper lip. Lip advancement achieves exposure of more of the pink mucosa (vermilion) and removes some of the vertical lip lines that run directly into the lips. A small strip of skin outside the lip line is removed to make the lips look bigger
There is really only one way to lift the downturned mouth corners. The corner of the mouth lift is performed to elevate the down turned corners of the mouth so that the smile line (lips at rest) becomes more horizontal. This makes one’s mouth appearance more perky. This is done by removing a small triangle of skin above each corner which changes the location and angulation of the sides of the mouth.
Just beyond the corner of the mouth can lie folds of skin which hang down. While it is tempting to think that this loose skin can be improved by a facelift, it usually is not. These “parachute” folds of skin can be improved by direct excision of loose skin and fat in the lower portion of the nasolabial fold. This excision of skin places a small scar along the lower end of the nasolabial fold. It can also help with some minor lifting of the corners of the mouth as well.
Any direct excision of skin in the mouth area do result in scars. Patients have to be willing to accept that trade-off for the benefit of mouth rejuvenation effects. While most of these scars heal well and very indiscriminately, some may need revision or smoothing out later. In my Indianapolis plastic surgery experience, these small revision rates are most commonly needed for corner of the mouth lifts and about 10% to 15% of patients may benefit by them.
Dr. Barry Eppley