Facial aging takes a toll on our lower face as skin thins, fat atrophies and descends, and wrinkles form. Three common problems people come in for are deep nasolabial folds (the crease from your nose to the edge of your mouth), vertical lip lines (sometimes called smoker’s lines, but not exclusive to smokers), and small or fading lips. All of these changes are tell-tale signs of aging, but there are products available that do a great job of reducing their appearance. Let’s look at each one.

Nasolabial folds:

nasolabial folds

Nasolabial folds (arrow)

These folds are present in everyone who ever smiled, but as your facial skin becomes less elastic and facial fat shrinks away, the cheeks descend and form permanent nasolabial folds. These can be accentuated by significant weight loss, sleeping on your side, and skin damage due to tanning. Preventing them is ideal, but aside from using sunscreen, which won’t guarantee they’ll stay away, you can’t do much to avoid them. There are three main ways they are treated. 1) facial fillers such as Juvederm, Restylane and Radiesse are used to fill in the lines, restoring some of the lost volume. These can be injected both directly beneath the crease, but also into the cheeks above creating some minor lifting. In both instances, dramatic reduction of the lines can result. With most of these products, some improvement from baseline can be seen for about a year (more or less varying by individual). There are some risks, such as rare severe reactions to the fillers as well as over-placement of product. Restylane and Juvederm can be dissolved in place with a second injection, but Radiesse has to be expressed or surgically removed. All will fade with time if left in place.

Radiesse to the nasolabial folds

Nasolabial folds and mental crease (chin line) treated with Radiesse.

Vertical lip lines:

vertical lip lines

Vertical lip lines

Loss of fat around the mouth along with facial movements can lead to formation of vertical lip lines. Many people find these objectionable because they are associated with smoking and they make the person appear tired or unhappy.  Other than using sunscreen and not using your lips, you can’t do much to avoid them.  Four different treatments are commonly utilized.  Botox can be injected in small amount in several places along the lips to relax the muscles causing the lines.  This can, however, cause your mouth to move differently and look irregular when you smile.  Fillers, most commonly the hyaluronic acid varieties such as Juvederm and Restylane, can be injected in various patterns to soften the lines’ appearance.  Some people also inject collagen, but this tends to last for a much shorter time. Laser skin resurfacing has also been shown to improve the appearance of these lines.  Finally, dermabrasion, which is essentially sanding down the skin to remove the wrinkle, can be done.  I prefer the injectable fillers as they are not permanent, can be reversed if too heavy handed, are very unlikely to cause inadvertent scarring, and won’t generally affect your mouth movements.

 

Fading (flat) lips:

Progressive addition of Juvederm to the lips

Thin lips with progressive addition of Juvederm for volume

Lip fullness can be something you lose with time, or something you just never had. The ideal proportion of the female lips are about 40/60, or if you look straight at the total height of the upper and lower lips closed, the upper lip should be 40% and the lower lip 60% of the height. Most commonly, the upper lip is more flat or rolls in and under as we age, making it appear thin. To regain that ideal shape, you must replace volume. Similar to above, dermal fillers work very well for this. They are injected along the vermillion border (junction of normal skin and pink lip skin) near the central portion of the lip, as well as within the body of the pink tissue of the lip. The outer edges near the corners of the mouth are avoided to prevent that fish mouth appearance. Maintaining the proper proportions and being conservative with volume changes will make the lips appear full and youthful, not inflated.

Call our office at (801)264-4420 for a consultation to discuss dermal fillers and your options.
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