Mouth and Lip Issues

 

PROBLEMS AROUND THE MOUTH AND LIPS

Here are the top issues!  A more complete discussion can be found my book, The Surgery-Free Makeover: All You Need to Know for Great Skin and 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 $700 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.

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.

Link to Guide to Fillers: Restylane/Juvéderm, Cosmoderm

Link to Dr. Irwin Demonstrating Restylane on the naso labial folds on The Oprah Winfrey 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.

Link to Guide to Sculptra

The "parentheses"  lines can also be filled with Cosmoderm or Cosmoplast.  These are collagens, and no allergy testing is required.  They are best for filing finer lines on younger patients, and the cost is comparable to Restylane and Juvederm, but it only lasts approximately 3 months.

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 for fuller lips?

Juvéderm/Restylane are excellent at plumping lips. For $450 to $800, you can get immediate results with maintenance  approximately 2-3 times a year. I have a preference for Juvederm in the lips 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.

Link to Guide to Fillers: Restylane/Juvéderm

Upper lip lines and lip borders

Children tend to have a very clear border between the lip itself and the skin surrounding it. As we get older, sometimes that border gets a bit fuzzy. 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 like Cosmoderm, 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 (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.

To get an immediate result and to help those lines fade quickly, you can use CosmoPlast or CosmoDerm, which are collagen but do not require allergy testing.   Cosmoderm and Cosmoplast can produce an excellent result on upper lip lines. Restylane Fine Line, which is a lighter weight version of Restylane, can be a good option here. 

CosmoPlast and CosmoDerm can also be very good for enhancing the border between the lip and the skin around it without adding any volume to the lips. CosmoPlast and CosmoDerm seem to do a better job at defining the lip border than the Restylane/Juvéderm injections in my experience.

Link to Guide to Fillers: Juvederm/Restylane, Cosmoderm

If your lips are very sun damaged 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 very good. 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.

Link to Guide to TCA Peels

Link to Guide to Microdermabrasion and Light Peels

Lasers that build natural collagen (long-wave lasers) can also help with upper lip lines. 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 when combined with other treatments.

Fractional lasers are also being used to treat upper lip lines.  The Fraxel laser has produced some good results if the lines are mild to moderate. Expect 0-2 days of mild swelling and bronzing.  The ablative fractional lasers (like the Active FX or the Affirm), have a longer downtime (4-8 days), but they have also reported possibly better results than the Fraxel on the upper lip. I rarely recommend the carbon dioxide laser now because so few of my patients can afford to take the needed time off to heal.

Link to Guide to Fractional Lasers

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. 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.

Link to 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.

Link to Guide to Thermage

Link to Guide to Sculptra

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 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.

Link to Guide to Fillers: Restylane/Juvéderm

Link to Guide to Botox

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.

 

Link to Fillers: Restylane/Juvederm/Cosmoderm

From www.SkinTour.com and Dr. Brandith Irwin. Copyright 2008-2010 SkinTour LLC. All rights reserved. Journalists, bloggers, and media may reprint this without permission so long as they include this credit box with the article.