The Aging Process of the Perioral Area
The perioral area, which is the region around the mouth, ages as a result of a number of factors. In general, the loss of hyaluronic acid and collagen in the skin, which is a result of inherent aging, has a significant impact on this area. Additionally, the mandible’s loss of supporting bone density and the natural loss of subcutaneous fat, both of which can reduce overall volume, may cause problems in this region. Smoking and UV exposure, two extrinsic factors that harm the skin’s structure, elasticity, and texture, also contribute significantly to skin aging.
Main Concerns of Patients
Buccal fat descent, which results in marionette folds, is one of the main issues in the perioral region. Patients are also concerned about perioral lip lines that might develop from repeated lip-pursing. In addition, nasolabial folds, smoker’s lines, and lip thinning are frequently bothersome to patients.
Primary Patients Receiving Treatment for the Perioral Area
Although more and more young patients are seeking treatment for their lips, middle-aged women are the main demographic looking to rejuvenate this area. In addition, smokers frequently receive treatments in the perioral region to minimize the visibility of lines. Patients with uneven lips or over-injected vermilion borders, as well as those who have had unsuccessful lip procedures before, frequently seek perioral treatment.
Important Considerations When Diagnosing and Treating the Perioral Area
Doctors should carefully examine the dental area and profile when making an anatomical diagnosis. In addition, it’s important to carefully consider how the lips and teeth relate to the nose and chin. Look at the patient from the front and the profile. Always remember that less is more when treating the perioral area. Treatment outcomes that are safer and better generally result from using several small treatment modalities. There is a lower chance of causing vascular compression when less product is used.
Additionally, the entire face should be taken into account when performing the procedure, not just the perioral region. Focusing too much on a single problematic area while ignoring other features of the face is one of the common pitfalls. The patient’s expectations and desired results should be considered when treating the perioral area. Based on this confluence of variables, choose the best treatment strategy.
Wrinkles Around the Mouth
Determine the underlying causes of perioral lines through accurate diagnosis before treating them. The development of perioral lines can be attributed to a variety of factors, such as genetics, smoking, and excessive sun exposure. Depending on the underlying diagnosis and the severity of the lines, different treatment strategies are appropriate.
It is advised to administer Juvederm Volbella or Ultra 2 via microinjections into pursed lips to treat early lines. Small injections may be administered if support is required along the vermilion border.
Resurface the skin to remodel it for longer-lasting effects. Skin resurfacing techniques include vertical microneedling (Dermapen), peels (Enerpeel MA), soft surgery (Plexr), and fractional ablative laser (iPixel).
Treating Volume Loss in the Lips
The lips gradually thin as we age due to natural aging. Avoid losing the symmetry of the lips when treating volume loss there. The top to bottom lip should have a ratio of 1:1.6. Consider the patient’s profile as you carefully evaluate the lips’ proportion to the rest of the face.
It is best to use a cohesive filler, like Restylane Kysse. Depending on the desired treatment outcome and the patient’s perceptions of their profile and proportions, different treatment approaches are used. If the lip height needs to be raised, the vermilion border should be addressed.
The Marionette Area
Patients with marionette folds typically experience midface descent. So, before treating these lines, the midface should be evaluated. It is advised to use a deceptive strategy. However, patients should be advised that the results may not be as effective if they insist on using a direct approach.
You can inject simple hyaluronic acid fillers like Belotero Intense or Volume into and close to the affected areas. The main objective is to lift the area by supporting it rather than merely filling in the folds or lines. Avoid overfilling the area to ensure that the cheek and chin region blend together. The upper and lower lips should both have sufficient support at the same time. The proper amounts of cohesiveness, plasticity, and elasticity are required in a product to ensure that it doesn’t migrate or move. Use a cannula to inject the filler subcutaneously to lessen the chance of bruising.
Instead of addressing each nasolabial fold separately, the practitioner should accentuate the region to lift the midface. As a result, the volume loss at the lower part of the face can be corrected without weighing it down. These lines typically result from the disappearance of the cheek’s mid- and lateral fat compartments. As a result, during the course of treatment, these areas ought to take precedence.
Enhancing the Overall Look with Home Care
Patients should be enrolled in a skin health program for about two to four weeks before beginning intensive treatments. Then, to even out the texture of the skin, they should use retinol, hydroquinone, and/or non-hydroquinone products. To correct skin pigmentation, these products can be used separately or in conjunction. Retinol, a member of the vitamin A family, stimulates fibroblasts to encourage collagen regeneration. Vitamin A stimulates cell renewal, which helps to improve dull skin. A step-up treatment with varying Vitamin A levels is possible with products like Environ.
The perioral region can also be treated with products that contain vitamin C and epidermal growth factor (EGF). AlumierMD, Image Skincare, and Tebiskin are examples of this. Patients should regularly apply sunscreen while receiving home care to prevent further skin ageing and pigmentation.
Improving the Skin’s Overall Appearance
First, make a diagnosis and evaluate the patient’s medical background. Afterward, look at the skin’s condition (i.e. degree of oiliness, dehydration, dullness, and roughness). See if there are any enlarged pores. Skin hydration, elasticity, and texture can all be improved with fillers like Juvederm Volite, which produces noticeable results after just one treatment. The perioral area is made better and more hydrated by Restylane Skinboosters. Trichloroacetic acid (TCA) chemical peels can be applied at various concentrations to improve skin texture. TCA peels frequently produce smoother skin than other types of treatment. Laser peels can also be used to rejuvenate skin because they can tighten pores and encourage collagen synthesis.
Synergistic effects can be produced by combining several different treatments for the best outcomes. Chemical peels and fractional ablative laser procedures can typically produce noticeable results with little recovery time. They are particularly helpful in treating skin pigmentation and vascular changes brought on by aging and sun damage.
The Risks of Treating the Perioral Area
Complications from treating the highly vascularized perioral area could include swelling, necrosis, bruising, and hematoma. To reduce tissue trauma, care must be taken when inserting fillers. Intravascular injections have the potential to cause serious side effects like vascular occlusions. Additionally, there is a chance that the product will get into the superior or inferior labial artery. A cannula should be used for administration, and syringe aspiration should be carried out throughout administration to reduce the risk of complications. Other treatments, like laser skin resurfacing, carry a risk of both hyper- and hypopigmentation. Before receiving any perioral treatment, patients should be made aware of all the possible risks.
As with any procedure, it’s critical to comprehend the patient’s expectations and inform them of reasonable outcomes. For instance, patients should be aware that treatment only works to soften the appearance of lip lines; deep lip lines cannot be completely removed. In addition, practitioners should avoid over-injecting. It’s important to take precautions to preserve the lip’s natural functions when treating the perioral area.
Permanent Makeup to Enhance the Lips
Applying pigment to the skin can also improve the look of the lips. With ageing, the lip line frequently ages and loses fullness and definition. Permanent makeup aids in defining the lip line, giving the impression of greater volume.
To define the lip line and create a color-wash effect, use a lip blush to blend the lip line into the lips. An artificial appearance could result from just doing the lip line. If more lip volume is required, dermal fillers can be used in conjunction with permanent makeup. However, to lessen the risk of complications, permanent makeup procedures should be carried out six weeks after filler injections or earlier.