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Lips and Mouth

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. Unless these nasal labial folds are very deep, they can easily be filled with Restylane or Juvéderm. These injections last 4 to 6 months, and 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.

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, usually a series of 2-3 treatments 4 to 8 weeks apart are needed, followed by approximately one maintenance treatment per year.

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. Both Juvéderm and Restylane for lips are excellent options for a lip enhancement. You can get immediate results with maintenance approximately 2-3 times a year. Radiant prefers 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 the 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, but a combination of Botox, a little filler like Cosmoderm, and some laser work can greatly reduce and improve them. 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. Botox relaxes the muscles that contract to create those lines.

For 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.

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. You may need three or four peels, but the results can be very good, and are low-risk. TCA peel is a more significant peel. 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. 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 or lip wrinkles.  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.

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. At two treatments 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.

Longer-lasting solutions involve Thermage and Sculptra.  All of these treatments work better in combination than when used individually. A full-face Thermage produces slow tightening around the jaw and lower face over approximately 6 months. Sculptra treatments fills the cheeks will help to lift the skin that is sagging along the jaw line and creating these marionette’s lines. You will need two to three treatments approximately 4 to 8 weeks apart. 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 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 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.

 

To help you decide which treatment protocol is appropriate for you, call Radiant Medspa at 206-402-3063 in Seattle or 425-640-5900 in Lynnwood for a complimentary consultation.