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The Best Treatments for Lines around the Mouth

How can I treat lines around my mouth? There are three common types of lines around the mouth area that occur with facial aging that patients and our practice often expressed concern about one vertical lip lines or wrinkles above the lips to nasolabial folds also called parentheses lines that appear at the outer part of the mouth and taper into the nose area and three mesolabial folds which become more visible on the outer lower corners of the mouth often refer to as marionette lines these lines and folds are due to tissue changes associated with facial aging such as a decrease in facial volume from loss of bone fat and soft tissue as well as a reduction in skin thickness and quality I’ll talk about how I help my patients with these lines around the mouth in my practice I’m dr. Amiya Prasad I’m a board-certified cosmetic surgeon and fellowship trained oculofacial plastic and reconstructive surgeon I’ve been in practice in Manhattan and Long Island for over 20 years helping my patients with changes seen with facial aging is a core focus in my practice with particular emphasis on the lips and the area around the mouth referred to as the perioral area vertical lip lines is a term which refers generally to lines which appear above the upper lip these lines result from several contributing causes this means that each cause should be approached to get the most effective outcome deep lines that appear when the lips are puckered are caused by the activity of a muscle called the orbicularis Oris muscle the appearance of these deep creases can be improved by strategically reducing muscle activity using a neurotoxin like Botox as the activity of the muscle decreases the depth of the creases improve with consistent use of a neurotoxin over time the skin continues to be less creased with movement and the lines become less prominent a neurotoxin like Botox takes about three days to take effect and full effects are seen about two weeks I routinely see my patients at that time to evaluate the results and see if any enhancement is needed The effect of Botox or any neurotoxin decreases over several months so patients come in on an average of about every four months vertical lip lines can also be due to volume loss of fat and soft tissue beneath the skin volume loss due to aging causes loss of projection above the lip resulting in lines increases to be more visible by placing a hyaluronic acid filler like Restylane or Juvederm for a volumizing effect the skin is lifted slightly making the lines and creases appear more smooth filler application can be performed in a few minutes and can last between 6 and 12 months vertical lip lines can also be caused by diminishing skin quality the skin can lose collagen and elasticity due to aging to stimulate collagen and tighten the skin treatment like laser resurfacing or radiofrequency heating can be employed to induce a controlled injury response the body reacts to this controlled injury by producing collagen to heal this area the collagen response can also help smooth and skin and thereby improve the vertical lip lines the nasolabial folds or parentheses lines appear to deepen due to volume loss associated with aging the nasolabial fold can be improved indirectly by adding volume to the cheek as well as to the mid-face I add volume to these areas using a technique called structural volumizing also called the y lift where thicker hyaluronic acid fillers are placed at the bone level which is below the muscle layer this method restores volume where volume loss is most significant which is at the bone level unlike commonly practiced filler placement which is just below the skin deeper placement prevents filler from shifting thereby avoiding the doughy less youthful appearance seen commonly with traditional filler placement techniques in addition this structural volumizing technique also has a lifting effect that further softens the appearance of the nasolabial folds this Structural Volumizing technique came naturally to me as a surgeon with extensive experience in performing facial implant surgery and facial fracture repair so instead of placing silicone implants on top of the bone I place long lasting injectable fillers using thicker hyaluronic acid fillers like Juvederm Ultra Plus and Juvederm voluma the results of this procedure can last one to two years the lines and fold to start at the corners of the mouth and go downward are called mesolabial folds also known as marionette lines these folds are also due to volume loss caused by aging and are often treated at the same time as nasolabial folds we treat these lines with hyaluronic acid fillers like Juvederm Ultra Plus and Juvederm voluma one particular advance of hyaluronic acid fillers is the ease of reversal that is they can be dissolved with the enzyme hyaluronidase if someone is dissatisfied with their results this is an important differentiation because for this area we can also consider a filler like radius which is made up of calcium hydroxyapatite a material similar to bone which is also a long-lasting filler however radius cannot be dissolved we further addressed the mesolabial fault by adding volume and contour to the jaw line also at the bone level with Structural Volumizing the jaw line up to the chin tends to lose its continual contour and definition with age and this can also affect the appearance of the mouth by adding filler to the jaw line all the way to the chin to make the contour more continuous and defined the volume correction can also improve the appearance of mesolabial these filler treatments take minutes to perform and patients can see improvement immediately there may be a little temporary swelling after treatment but this is generally minimal and resolves quickly I regularly see cosmetic filler patients two weeks after treatment to see how the filler has settled and if any additional enhancement is needed patients can even have this type of treatment done shortly before an important event like a wedding in my opinion filler placement is to be treated as seriously as surgery once you’ve entered below the skin in my mind the procedure is invasive fillers are often applied by non physicians and doctors who don’t perform surgery as I mentioned earlier I feel that my experience as a surgeon has been very useful in how I place fillers particularly at the level allowing my patients to have consistently satisfying outcomes with minimal swelling and rarely experiencing any bruising I hope you found this information helpful thank you for your question

Lines around the mouth, or perioral area, is a common concern I frequently hear about. These lines can remain visible even without movement, or become more pronounced with muscle activity. I’ll discuss some cosmetic treatments that can address these particular concerns.

I’m Dr Amiya Prasad. I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculofacial Plastic and Reconstructive Surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years. I have a lot of experience performing facelifts, upper eyelid surgery, eyelid ptosis surgery, Asian eyelid surgery, under eye bag surgery, hair restoration and as well as working with injectable fillers.

The most common types of lines that occur around the mouth area are vertical lip lines, nasolabial folds, and mesolabial folds. These folds occur due to a decrease in facial volume from loss of fat and soft tissue. A general reduction in skin quality as we age can also contribute to this.

3 types of lines around the mouth

There are 3 common types of lines around the mouth: vertical lip lines, nasolabial folds, and mesolabial folds.

Vertical Lip Lines

Vertical lip lines are pronounced creases that occur above the upper lip when the lips are pursed. This is caused by the activity of the orbicularis oris muscle. To resolve this, a neurotoxin like Botox is used to reduce muscle activity. This then reduces the depth of the creases, making them less visible.

Botox typically takes about 3 days to take effect, with the full effects manifesting in about 2 weeks. At the 2-week mark, I evaluate the results and see if any enhancement is needed. The effects of Botox usually subsides over several months, so maintenance treatments are advised every 4 months.

Vertical lip lines before and after Botox

Botox can help vertical lip lines, which can fully take effect after 2 weeks, and subsides over several months.

Volume loss in the fat and soft tissue layers beneath the skin are also responsible for vertical lip lines. Volume loss reduces projection above the lip, resulting in lines becoming more prominent. These lines can be filled and smoothened out with the help of a filler like Restylane or Juvederm. Filler treatment can be performed in a few minutes and can last anywhere between 6-12 months.

Vertical lip lines before and after fillers.

Hyaluronic acid fillers can improve vertical lip lines. Treatment can be performed in a few minutes and can last anywhere between 6-12 months.

Diminishing skin quality is another known cause for vertical lip lines. As we age, our skin naturally loses collagen and elasticity. To combat this, treatments like laser resurfacing or radiofrequency heating can be employed. These treatments induce a controlled injury response that stimulates collagen production and tightens skin.

vertical lip lines before and after laser

Laser treatment can be used to resurface the skin above the upper lip, tighten the skin, and stimulate collagen to improve the depth of vertical lines.

Nasolabial Folds

Nasolabial folds, or parentheses lines, bracket both sides of the nose and mouth areas. Nasolabial folds become more pronounced as age-related volume loss progresses. To address this, I perform a procedure called Structural Volumizing. With this method, thicker hyaluronic acid fillers are strategically placed in the cheek and mid-face areas at the bone level.

Before and after of Structural Volumizing performed by Dr. Prasad

Dr. Amiya Prasad treats nasolabial folds with Structural Volumizing, also called Y Lift, where thicker fillers are placed at the bone level, and underneath the muscle layer.

As a surgeon with extensive experience with facial implants and facial fracture repair, the Structural Volumizing technique came naturally to me. Instead of placing implants on top of the bone, I worked on the technique of placing thick, long-lasting fillers instead.

Conventional filler placement puts the filler just below the skin layer. Placing the filler deeper restores volume where it is most needed. This method also prevents the filler from shifting around under the skin. Deeper placement also avoids the typical “doughy” appearance that is commonly seen. This particular method produced results that can last for 1-2 years.

Structural Volumizing before and after

Deeper placement of filler for nasolabial folds can last for 1-2 years.

Mesolabial Folds

Lines that begin at the corner of the mouth and go downwards are called mesolabial folds, or marionette lines. Similar to nasolabial folds, these lines are also caused by volume loss and are often treated together using the same methodology. Aside from hyaluronic acid fillers, Radiesse is often used in this area, but it’s not made of hyaluronic acid, but of calcium hydroxyapatite, which is similar to bone. The difference is that calcium hydroxyapatite cannot be dissolved or reversed like hyaluronic acid filler. The effects of Radiesse last about a year, while thicker hyaluronic acid fillers like Juvederm Voluma can last about 2 years.

Marionette lines treatment before and after

Fillers like Juvederm Ultra Plus and Juvederm Voluma are treatment options for marionette lines.

Mesolabial folds are addressed by placing volume in the jawline area by means of Structural Volumizing. As we age, loss of definition in the jawline affects the appearance of the mouth. Adding volume to this area improves definition and makes the overall contour more continuous and angular.

Generally, filler treatments take only minutes to perform. Minimal swelling can occur but usually resolves quickly. Patients can even undergo this treatment shortly before an important event like a wedding. My patient care policy post-treatment includes regular check-ups to monitor results and see if any additional enhancements are needed.

In my opinion, filler placement should be treated as seriously as facial cosmetic surgery. I believe that once you’ve entered below the skin, the procedure is already considered invasive. As such, it should be handled with the same standards one uses for all invasive procedures.

Nasolabial and mesolabial folds before and after filler treatment

Filler treatments take only minutes to perform to improve fine lines around the mouth. Minimal swelling is expected but can resolves quickly.

Filler Treatments are Not All the Same

In many practices, filler treatment can be administered by non-physicians and doctors who don’t perform surgery. It’s important to understand that filler treatment is a procedure that requires skill and finesse. Knowledge of surgical techniques is important, especially when placing filler in deeper areas. I do advise patients to meet with doctors who can perform both surgery and filler treatment to get an unbiased recommendation of what will be best for a particular person.

I personally feel that my experience as a cosmetic surgeon has been very useful in achieving outstanding results. My expertise in facial anatomy and a natural aesthetic style allow my patients to have consistently satisfying results with minimal swelling and rarely any bruising. Choosing fillers made of hyaluronic acid are ideal for longevity, safety, and reversibility.


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