Perioral rejuvenation: restoration of attractiveness in aging females by minimally invasive procedures

Abstract

Lips and the perioral area are of outstanding importance in youthful appearance, attractiveness, and beauty. In contrast to younger and middle aged females, there is only scant published data on minimally invasive procedures to restore and revitalize lips and perioral soft tissue in elderly females. In this review we report the signs of aging in this particular region and the underlying anatomy. We review studies on lip restoration in younger females and present our techniques for elderly women. With an individually tailored approach, elderly females benefit from minimally invasive techniques.

Keywords: anatomy; dermal fillers; facial aging; lips; perioral soft tissue.

Figure 1

Anatomy of upper and lower lip region. Notes: (A) Upper lip showing (1) the nasolabial deep fat pad, (2) the superficial fat layer with delicate small lobules, and (3) collumella of the philtrum. (B) Lower lip showing (1) the superficial fat layer with larger lobules than in the midface, (2) the deep fat pad between mentalis muscle branches, (3) orbicularis oris muscle and (4) the lower lip with small lobules of superficial fat.

Figure 2

A 55-year-old woman with thin lips and perioral fine lines and elongation of the philtrum. Notes: (A) Before treatment lip fullness scale (LFS) 0 (upper lip) and 1 (lower lip); marionette line grading scale 1. (B) After liquid lift for the cheeks with 2 mL Juvederm voluma, the perioral region has been remarkably improved. The marionette lines smoothened and the upper lip LFS increased by 1 scoring grade. The whole perioral area remained untouched by the filler. This example underlines the importance of the nasolabial fat pad for upper lip aesthetics.

Figure 3

A 45-year-old woman with thin lips and flat philtrum. Notes: (A) Before treatment lip fullness scale 0 (upper lip) and 1 (lower lip); marionette line grading scale 0. (B) volume restoration of philtrum collumelas and vermillion border by 1 mL Juverderm ultrasmile; lip fullness scale 1 (upper lip).

Figure 4

A 67-year-old woman with perioral fine lines and flattening of philtrum collumelas. Notes: (A) Before treatment lip fullness scale 2 and marionette line grading scale 2. (B) After restoration of collumellas and volumizing of the white roll (upper lip) along the vermillion border with 2 mL Juvederm ultrasmile, lip fullness scale 4 (upper lip), marionette line grading scale 1. There is improvement of fine lines as well.

Figure 5

A 60-year-old woman with flattening of Cupid’s bow and downward turn of the commissures. Notes: (A) Before treatment lip fullness scale 1 for upper lip and 2 for lower lip; marionette line grading scale 2 (left side) and 3 (right side). (B) volume restoration of philtrum collumelas, a small amount of filler was injected along the vermillion border of the upper lip and volumizing the lateral lower lip. There is smoothening of asymmetries of the perioral area and hyaluronic acid filler 2 mL Belotero basic was used.

Figure 6

A 68-year-old woman with flattening of Cupid’s bow, thinning of white rolls, perioral fine lines, and marionette lines. Notes: (A) Before treatment lip fullness scale 0 (upper lip) and 1 (lower lip); marionette line grading scale 4 (left side) and 3 (right side). (B) After treatment with hyaluronic filler showing restoration of upper lip vermillion borders and philtrum collumelas by 1 mL Juvederm ultrasmile and marionette lines by 2 mL Belotero basic. Lip fullness scale 1 (for upper lip; lower lip left untreated) and marionette line grading scale 1 (for both sides). Asymmetries have been corrected.