The eyes may be the window to the soul, but the mouth is where we most commonly maintain contact, making it a crucial area in facial harmony. As we age noticeable changes occur. A deepening of the nasolabial folds, thinning of the lips, marionette lines, jowls and lip lines become more apparent. Fillers can act as the first line of defense against loss of volume or correcting lines. Downturned lips can be “lifted” with properly placed fillers just outside the corners of the mouth. Botox can be used strategically around lip lines as a preventative measure stopping new lines from forming. Ulthera® tightens and lifts the skin and surrounding area. The bottom line? A holistic approach using a combination of treatments is the best philosophy.
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But what can be done to add permanent volume, define a lost lip border or shorten an upper lip that is too long? And what role does bony support play in aging the perioral region? Overall facial aesthetics are profoundly affected by the mouth, and yet it remains the orphan stepchild of facial rejuvenation. Lip augmentation—while not always done with restraint—is well accepted. Lip lifts however don’t enjoy the attention they deserve as being part of that aesthetic unit. A lip lift is indicated when the loss of bony support in the middle third of the face begins to erode, causing the upper lip to slip down over the upper teeth. As this process marches on, and is left untreated, it ultimately affects the upper and lower lips and corners of the mouth. This dramatically changes a person’s expression and is a telltale sign of an aging face.
A lip lift can be done as an isolated procedure for those with genetically elongated lips, which are thin and drooping prematurely. Alternatively, it is performed as part of a thoughtful facial rejuvenation. The primary reasons for hesitancy on the part of the patient are due to fear of an obvious scar and results that over emphasize the upper lip making it seem unnatural. Both of these concerns can be satisfactorily countered during the consultation. Photos will quickly dispel the notion that lip lifts carry a greater than average risk of a poor result. In fact, not addressing the perioral region is one of the biggest mistakes in facial rejuvenation, leading to imbalance of aesthetics now and gaining later. It is a sin of omission that will only draw attention to the unimproved area being perpetually out of balance.
- What part(s) of body treated by this method: mouth, upper lip, nasal labial folds, nose above white and red upper lip
- Time for procedure: 30-45 min
- Anesthesia: Local, local with sedation or general
- Number of sessions required: One
- Downtime: 3-5 days
- Complications/Risks: a scar may be visible temporarily
- How long results last: 8-10 years
- Cost of Lip Lift ($/$$/$$$): $
One on one with Dr. Kornstein
Almost everyone can point to their nasal labial folds—the lines that run from the outside of the nostrils down to the corners of the mouth. The widespread popularity of fillers has put a spotlight on correcting or minimizing these lines. But can you find your pyriform aperture? If you put your finger at the top of your nasolabial fold where it meets the side of your nose you will be touching the pyriform aperture. This area might not get a lot of press, but bone loss here is the cause of one of the earliest and most profound areas of facial aging.
In a youthful lip posture with the mouth relaxed and slightly open, the tips of the 4 central teeth should be visible and lower teeth are hidden. The gradual loss of volume of bone in the pyriform aperture undermines the support system for the upper lip causing the lip to slip down, eventually covering the upper teeth. As aging occurs, the tips of the upper teeth are covered by a descending upper lip. At the same time bone loss in the chin area renders the lower lip elevator muscles less efficient, exposing the lower teeth. As the upper lip continues to slip off its bony support the lip elongates and thins. In early stages thinning of the lip is what is most commonly noticed by patients. At that point, the symptoms can be treated by injections into the red lip to augment the volume of the red lip. Fillers can also help correct thinning of the skin over the white lip which leads to vertical wrinkles both at rest and during animation.
A further anatomy lesson involves an area called the oral commissure—another word for the corners of your mouth. Descent of the upper lip contributes to descent and downward inclination of the corners of the mouth leading to a sad or despondent expression. Downward inclination of the oral commissure is also seen when the cheek sags, adding downward pressure. True correction at this juncture involves a facelift to elevate the deep tissues between the skin and muscle eliminating pressure on the oral commissure. If there is significant atrophy of the tissues both at the corners of the mouth and just below the lower lip, either fillers or a commissure graft may be advised.
A lip lift performed under local anesthesia is nothing short of dramatic in terms of restoring youthfulness to the lower third of the face. In my experience it is a common prescription in two specific scenarios:
As an isolated exercise where the patient realizes their upper lip is aged and elongated and requests treatment targeting this area.
The other is my suggestion to the patient as part of a global facial rejuvenation effort. In this scenario patients are typically skeptical or afraid of the changes to the upper lip and secondarily the potential scarring at the base of the nose. In my opinion this is due in large part to the overly dramaticized lips present on Park Avenue. These notions are dispelled by taking the patient through my photo gallery of pre and post op photos and/or speaking to patients who have had the procedure. Most patients have a “eureka” moment when they see the power of this simple procedure.
Why are lip lifts shrouded in misconception, kept mysterious or ignored altogether? There are many procedures in plastic surgery that have a poor reputation that is undeserved. This “bad rap” is promulgated from person to person regardless of facts. For those who feel that the lip scar would be obvious—I would raise the point that nostril reductions are routinely performed with little angst about scarring. The lip lift scar is in the same location. As with any procedure, you have to do your homework and trust in surgical skill and judgment, demonstrated experience and results in the surgeon’s photo library. Any operation can be overdone. It is not the nature of the operation that is at fault, but the way in which it is performed.
I strongly contend that rejuvenation of the perioral region is critical to a harmonious facial rejuvenation. This becomes most obvious when facelifts are performed and there is little or no attempt to rejuvenate the mouth. This approach ignores some of the earliest signs of facial aging brought on by loss of bony support.
It is clear to me after 20 years of treating facial rejuvenation patients that the mouth is the focus of attention during discourse. Therefore aging elements present will be firmly ingrained in the observer’s mind and the absence of correction in an otherwise rejuvenated face will only call attention to what was left “undone.”