Mouth and Lip Issues

Here are the top issues!  A more complete discussion can be found in my book, The Surgery-Free Makeover: All You Need to Know for Great Skin and a Younger Face.

Lines from your nose to your mouth

The lines that curve down from the outer edges of the nose to the outer edges of the mouth can sometimes almost look like parentheses around our mouth. In some people, these can get very pronounced as they age.

The medical term for these is the nasal labial fold, so you may hear that expression as you read literature in this area.

Unless these nasal labial folds are very deep, we can easily fill these with Restylane or Juvéderm. These injections last 4 to 6 months on average. Costs can run from $450 to $900 per syringe, with most people needing one or two syringes.  Both companies now make a thicker, higher molecular weight version that can last 6-9 months. It is just slightly more expensive.  Cosmoderm/Cosmoplast were taken off the market – not due to any problem but because they were bought by Allergan who distributes Juvederm.

These hyaluronic acid fillers have been used now for many years with an excellent safety profile. I demonstrated Restylane on these nasal labial lines on the Oprah Winfrey show and the Today show.

Lines from the nose to mouth or mouth to chin can also be lifted and filled with injections of Sculptra. Sculptra is a newer and longer-lasting treatment than Restylane or Juvéderm. Sculptra is FDA approved for HIV with broader approval pending.

Sculptra stimulates collagen growth deep in the skin. You may want to start with Restylane or Juvéderm to make sure you like the effect before committing to something that lasts 1-2 years. It is also significantly more expensive than Juvederm/Restylane. Sculptra costs $800-2,000 per treatment and usually a series of 2-3 treatments 4 to 8 weeks apart are needed, followed by approximately one maintenance treatment per year.

Some patients ask me why I don’t recommend permanent fillers like Artefill or silicone. In my opinion, the risks from these do not outweigh the advantages. There have been reports of some allergic reactions to permanent fillers as many as 2 to 10 years after the injection. And, what if the doctor or nurse performing the permanent filler injection makes a mistake?

Maybe most important, a permanent filler may look good at age 50 but may look very different after a face has aged around it and reaches age 60. Faces, and body weights for that matter, don’t stay exactly the same. A permanent filler can’t be easily adjusted.

One other tip is to be careful not to overfill this line from the nose down to the mouth. If it gets too flat or even convex (not good!), it loses its natural shape. Even children have a gentle inward curve here.

I think good cosmetic filler work should be virtually unnoticeable after the first 7 days. You should look rested, refreshed, and natural, not overstuffed or wooden. So, be conservative for the first few visits for fillers.

Thin lips

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. For $450 to $800, you can get immediate results with maintenance approximately 2-3 times a year. I have a preference for Juvederm lip enhancement injections because it’s a little smoother, less prone to bumps and causes less puffiness for the first day or two but both work well. As with the lines from the nose to the mouth, it is best to start conservatively and gradually add more if desired, rather than risk having your lips look unnatural.

Upper lip lines and lip borders

When we are young we tend to have a very clear border between the lip itself and the skin surrounding it. However, as we get older, sometimes that border gets a bit fuzzy and there will be wrinkles on the upper lip. Some of us also get lines that radiate up from our upper lips. These are upper lip lines.

There is no single treatment that magically eliminates these lines (darn!) but a combination of a little Botox, a little filler, and some laser work can greatly reduce and improve them. The closest thing to a magic wand on the upper lip is a carbon dioxide laser resurfacing, but it often leaves a color mismatch (a whiter area) with the surrounding skin and takes a long time to heal. There is some risk of scarring.

A small amount of Botox can help prevent deepening of existing lines and wrinkles around mouth(a preventive effect) and may reduce existing lines a little. For $200 or less (particularly if you are having Botox somewhere else and your injector can use a small amount here), Botox can help relax the muscles that contract to create those lines.

If you have very sun damaged lips and that is causing the lip border to be indistinct, peels may help. The options are lighter peels, like glycolic or salicylic peels, or a medium TCA peel. The glycolic or salicylic peels cost about $100 to $300 per peel. You may need three or four peels, but the results can be good if the lines aren’t deep. These are generally low-risk, another plus.TCA peel is a more significant peel and costs between $350 and $750. Because the TCA peel is a stronger chemical peel, be sure to see a dermatologist for this treatment.

Lasers that build natural collagen (long-wave lasers) can also help with upper lip lines and lines around mouth. These are no-downtime lasers that are gentle. You will probably need three to five treatments approximately 2 to 4 weeks apart. Costs vary widely with the region and type of laser used. The results won’t be apparent for 3 months or more, but stimulation of the natural collagen will help with these upper lip lines.  Again, not a home run but a gradual process that works for smaller and finer lines when combined with other treatments.

Fractional lasers are the best way to treat upper lip lines or lip wrinkles.  The Fraxel laser has produced some good results if the lines are mild to moderate. Expect 2-4 days of mild swelling, redness and bronzing.  The fractional CO2 lasers (like the Active FX or the Deka DOT), have a longer downtime (3-7 days), but they give much better results than other lasers for upper and lower lips lines.  They have the added advantage of being able to make the vermillion (colored edge) border sharper and more distinct if the laser is run up just onto he lips.  It blurs with age and sun damage.

Marionette’s lines

Marionette’s 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.

There are a couple of different good ways to treat these mouth wrinkles. Restylane or Juvéderm (usually used here in their heavier molecular weights, Perlane and Juvederm Ultra Plus) will fill these lines and give an immediate improvement. For $450 to $700 per treatment for one syringe twice a year, many women find this a good option. You may need two syringes if your lines are deep. You do need to repeat the treatment every 4 to 6 months.

See Dr. Irwin’s Guide to Fillers: Restylane/Juvéderm

Longer-lasting solutions involve Thermage and Sculptra.  All of these treatments work better in combination than when used individually.

A full-face Thermage will cost $2,000 to $3,000 and will produce slow tightening around the jaw and lower face over approximately 6 months.

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

Some of us notice that the corners of our mouth begin to droop or turn down as we age. This again is gravity’s work, as we lose our natural support that holds the corners up.

Juvederm/Restylane lip injections give a good result filling the surrounding supporting skin and lifting the corners of your mouth. Restylane will cost $450 to $700 per syringe (usually one is needed) and will give an immediate lift.

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.

Next, learn about Cheek Issues.

See Dr. Irwin’s expert answers to other reader’s questions on Mouth and Lip Issues:
If I’m 46, what would work best for the lines around my mouth?
Why do my lips look different after a filler in the upper lip lines?
Will Sculptra help with my smoker’s lines and frown lines?