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There are many physical signs that can give away one’s age. Women know these signs very well and they include such areas as the back of one’s hands, the neck at the sternal notch area, and the mouth. The mouth area is a particularly bothersome area for many women. As a plastic surgeon, the mouth seems to be an area that unfairly ages in women much more than in men. It is actually rare to see deep vertical lip lines in men, even if they have thin lips, until they get quite elderly.

In the November 2009 issue of the Aesthetic Surgery Journal,  a study was reported to investigate the differences between men and women around the mouth area.To determine how bad the wrinkles were, the upper lip of male and female fresh cadavers were analyzed using three-dimensional digital imaging and as well as histologic assessment of full-thickness lip resections in different male and female cadavers. Their results showed that women had more and deeper wrinkles than men. Men had a significantly higher number of sebaceous, sweat glands, and blood vessels in their skin. Somewhat surprisingly, the number of hair follicles did not significantly differ between men and women, although men had a higher number of sweat glands per hair follicle.

This study provides scientific evidence as to why women are more susceptible to the development of mouth and lip wrinkles.The skin around the mouth in women has lesser numbers of skin appendages (hair follicles and oil glands) as well as different connections between the skin and the muscles of the lips.

The key anatomic factor is that with less oil glands, there is less oil production to help keep the skin softer, smoother and better protected. I think the observation that the muscles around the mouth are closer to the skin in women than men is also important. This may allow the muscles to pull the skin in tighter, creating a ‘purse-string effect’ and causing more wrinkles.

Outside of this study, there are likely other contributing factors that accentuate these anatomic findings. One of these is the drop in estrogen in women with aging. This hormonal change causes a decrease in the fat (sebum) secreted by sweat glands. Coincidentally, women on hormone replacement therapy have been reported to have fewer wrinkles than those not taking the hormones. Also, most men perform a daily wrinkle treatment, shaving which is a  form of microdermabrasion. Such superficial skin exfoliation done tens of thousands of time over one’s lifetime will help lessen wrinkling also.

While avoiding smoking and sun exposure and using daily moisturizers are extremely helpful and will reduce the amount of wrinkling which will develop, that advice does little for the women who already has significant signs of mouth aging.

Several treatment strategies exist that can help significantly with lip lines and wrinkles. These include injectable fillers, Botox, laser resurfacing, chemical peels, and fat injections. The fundamental concepts of these strategies (with the exception of Botox) is inflation (volume fill or restoration) and smoothing. While everyone does not need all or even most of them, a combination of inflation and smoothing will work better than just one of the concepts. Most commonly, the combination of injectable fillers and laser resurfacing is used. But treatment approaches can differ and I do not always do the same approach for everyone.

The anatomy of lip wrinkles indicates that no matter what is done, none of the treatment approaches actually ‘cures’ the problem. The skin of the lip can not be made permanently thicker and the natural oil production of the skin can not be improved. This indicates that no matter what treatments are done, they will have to be eventually repeated to maintain the improvement.  

Dr. Barry Eppley

Indianapolis, Indiana

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