Background: All areas of the face eventually show the signs of aging. But the mouth area in women is affected more by aging than that seen in men and is affected by sagging, thinning and wrinkling. The once fuller lips of youth give way to thinner lips with less vermilion show and vertical lip lines. The corners of the mouth turn down and jowling develops from the descent of tissues from above. Collectively put together this creates an older and unhappy mouth appearance.
While many plastic surgery procedures exist to treat the aging face, the most recognized ones do not have any influence on the mouth area. A facelift is a great procedure to improve the neck and jowls but does not affect the more central mouth region. Cheek lifts improve midface volume and sagging but will not turn a frown into a smile.
An aging mouth can only be improved by a direct approach and not peripheral pulling or lifting. This requires a series of different small procedures performed directly on the various aging mouth issues. Corner of the mouth lifts, laser resurfacing, lip lifts and advancements, lip volume augmentation and perioral mound liposuction all make up a collection of procedures under the category of perioral rejuvenation.
Case Study: This 57 year-old female wanted to improve the look of her mouth. She felt it looked old and constantly frowned. The corners were turned down and she had moderate jowling and fullness to the side of her mouth. She had excellent lip volume for her age and good skin with very few vertical lip wrinkles.
Under general anesthesia (she was having numerous other facial procedures), she had a corner of the mouth lift combined with perioral mound liposuction. The corner of mouth lift was performed using a small triangular cutout of skin obliquely oriented along the depressed mouth corners. Through a small mucosal incision just inside the corners, a 2mm cannula was used to remove 1.5ccs of fat from each perioral mound area down to the jowls.
These small mouth-related procedures produced a subtle but visible change in the appearance of her mouth giving it a more pleasing and youthful appearance. The smile line was now level and the convexities (bulges) on the side of the mouth were turned into more shapely concavities.
The relatively obscure corner of the mouth lift has been around for over 75 years and, despite its simplicity, is the only procedure that can produce a permanent improvement for downturned mouth corners. It is a very small area of skin excision but it has to be marked out and executed very carefully to avoid visible scarring. Even when done well, there is a 20% to 30% incidence of minor touchups to the scar(s). Perioral mound liposuction is even less well known but less than 2ccs of fat removal can get rid of undesireable fullness and tissue sagging.
Case Highlights:
1) Aging of the mouth causes a variety of changes including downturning of the corners of the mouth, lip lines, marionette lines and jowling.
2) Perioral rejuvenation includes a variety of procedures including correction of frowning with a corner of the mouth lift.
3) Perioral mound liposuction can help get rid of the sagging fullness to the side of the mouth.
Dr. Barry Eppley
Indianapolis, Indiana