Sunday, June 3, 2012

Nips and Tucks For the Aging Mouth

Plastic Surgery - Nips and Tucks For the Aging Mouth
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The changes nearby a woman's mouth is one of the telltale and bothersome signs of facial aging. It is not just the lines and wrinkles but other anatomic changes that make the mouth look older. The upper lip begins to get longer and thinner. The drooping skin from above the lips forces the corners of the mouth to turn downward. As the corners turn downward, furrows increase from the corner of the mouth towards the jaw line known as marionette lines. The lower lip sags and the horizontal groove under it (labiomental sulcus) becomes more pronounced. The nasolabial folds or lip-cheek grooves, which bracket the mouth from above, come to be deeper and more obvious.

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Reducing wrinkles round the mouth straight through skin resurfacing methods, using lasers or chemical peels, is helpful but they address only one part of the problem for many. Injectable fillers add a good recipe of rejuvenation because they replace lost volume and help supply a small lift to some areas of the mouth. When combined with skin resurfacing, some nice changes in the aging mouth can be seen.

In some cases, the mouth or perioral area requires some surgical manipulation to get that more youthful look. There is a set of small but very efficient mouth procedures that are more efficient at lifting and upturning than any injectable filler alone. The goal here is to have fuller lips with a more even or horizontal smile line. These perioral rejuvenation procedures include lifts of the lip, corner of the mouth, and smile lines.

The simplest lift is that of the upper lip. It is performed to shorten the long lip of aging, allowing the upper teeth to show slightly when the lips are slightly open. By using a wavy or bullhorn-shaped ellipse of skin under the nose, the central part of the lip is upturned. Lip advancements, however, are more widely used as they affect the entire upper lip. Lip advancement achieves exposure of more of the pink mucosa (vermilion) and removes some of the vertical lip lines that run directly into the lips. A small strip of skin covering the lip line is removed to make the lips look bigger

There is in fact only one way to lift the downturned mouth corners. The corner of the mouth lift is performed to elevate the down turned corners of the mouth so that the smile line (lips at rest) becomes more horizontal. This makes one's mouth appearance more perky. This is done by removing a small triangle of skin above each corner which changes the location and angulation of the sides of the mouth.

Just beyond the corner of the mouth can lie folds of skin which hang down. While it is tempting to think that this loose skin can be improved by a facelift, it ordinarily is not. These "parachute" folds of skin can be improved by direct excision of loose skin and fat in the lower part of the nasolabial fold. This excision of skin places a small scar along the lower end of the nasolabial fold. It can also help with some minor lifting of the corners of the mouth as well.

Any direct excision of skin in the mouth area do supervene in scars. Patients have to be willing to accept that trade-off for the advantage of mouth rejuvenation effects. While most of these scars heal well and very indiscriminately, some may need revision or smoothing out later. In my Indianapolis plastic surgical operation experience, these small revision rates are most commonly needed for corner of the mouth lifts and about 10% to 15% of patients may advantage by them.

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