As the face ages, so does the mouth area as well. Many perioral changes take place that go beyond the development of wrinkles and vertical lip lines. The upper lip may get longer, the corners of the mouth may droop, and both upper and lower lips get thinner and lose any poutiness. Three distinct grooves also develop including the nasolabial lines (oblique lip-cheek grooves), marionette lines (vertical chin-facial groove) and the horizontal labiomental groove below the lower lip.
Collectively, any number of these mouth area changes create an older aging lower face and often creates a sad, angry, or unhappy look. While skin resurfacing methods, such as chemical peels or laser treatments, are a part of perioral rejuvenation strategies, they do not make enough of an appearance difference to be used a stand alone treatment. As is well known, no form of a facelift or necklift procedure provides any improvement to the aging mouth.
As the aging mouth presents the conceptual issues of a thinning and downturned problem, appropriate treatments should be those that create thickening and uplifting solutions. One must, therefore, look at combining direct surgical approaches (e.g., lip lifts and advancements) with injectable fillers.
While there are a variety of differing combinations of these surgical and non-surgical mouth procedures, one of my favorite is the use of injectable fillers for the nasolabial folds and a corner of the mouth lift. This combination is particularly effective because both treatments affect the same line of perioral aging. And both can be performed fairly quickly under local anesthesia in the office with no significant downtime.
The use of injectable fillers is a common and very effective method for most prominent nasolabial fold areas. They are not effective when the folds are so deep that they are inverted however. But for shallow and moderate depths folds, injectable fillers will provide a nice softening with an instantaneous result. There are numerous filler options and all will work. I prefer those that last the longest such as Juvaderm, Perlane, Radiesse, or Sculptra. Injection under an infraorbital local anesthetic nerve block makes the injection painless.
The corner of the mouth lift is done to turn up the corners of the mouth. This small procedure is quite powerful as it alters the sad mouth appearance. By removing a small triangle of overhanging or downturned skin above each mouth corner, the mouth line becomes level. This does result in a fine line white scar that lies along the upper lip border and extends slightly beyond the mouth corner. This does result in a scar but it is only visible on very close inspection. The little scar is red for a while but will fade to a white color over time. Tiny little dissolveable sutures are used and make-up can be applied immediately.
The combination of nasolabial fold augmentation with injectable fillers and a corner of the mouth lift helps address collateral areas of around the mouth aging. In my Indianapolis plastic surgery practice, this is done as an in-office procedure that takes about an hour under local anesthesia. These changes are effective and easy to go through with no recovery. Some corner of mouth lifts may require a touch-up but they are very long-lasting. Injectable fillers are not permanent and  will need to be repeated in about a year.
Dr. Barry Eppley
Indianapolis, Indiana