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