We’ve all seen the result of aesthetic treatments and surgeries gone awry. Add to this the inevitable ageing process, and you may have a worryingly unnatural appearance on your hands. Aesthetic treatments around the mouth and lips, in particular, are no exception. Dr Michelle Hutton explains what happens to the face as we age and details her approach to treating the area around the mouth to ensure natural-looking results that stand the test of time.
In this day and age, we are all too familiar with the large, overdone lips strewn across social media. I feel we are on a slippery slope in the aesthetic industry when it comes to treating the peri-oral area, and more understanding and knowledge is needed by both patients and injectors before embarking on this journey.
What is the peri-oral area?
The peri-oral area of your face is the area immediately surrounding your mouth and includes the lips, upper lip area under the nose, nasolabial folds (smile or laugh lines), and the corners of the mouth.
It is vital for me as an aesthetic injector and medical doctor to visualise how my patient is going to age and what the ramifications will be in 40–60 years’ time after administering these injections.
We are seeing a trend towards large volumes of lip filler being injected in single sittings. At a young age, lip skin is incredibly healthy, forgiving, and accepting of larger amounts of filler. So, your lips may end up looking fabulous in your 20s, 30s, and even early 40s.
The problem comes in as our peri-oral area starts to age. You need to consider what your lips will look like in your golden years. The concern is twofold: damage to the vermilion border (the defined demarcation between the lip and the adjacent normal skin) due to misplaced filler or filler migration, as well as the overstretching of lip tissue and skin due to large volumes of filler. This is something we simply cannot fix.
There are numerous clinics today that thrive off the correction of the peri-oral area, involving the dissolving of dermal fillers. This alone should be a red flag in the industry and to us as medical doctors.
So, to best understand what treatment is right for you in this area, we need to understand the anatomy of this area and how it ages.
Factors behind facial ageing
As we age, the following factors take their toll on this part of the face:
- Sun exposure and in some cases histological changes in the skin
- Bone resorption of the maxilla and mandible
- Dynamic contraction of the peri-oral musculature
- Gravitational pull
- Unhealthy peri-oral habits and smoking
Results of facial ageing
This combination of factors leads to:
- Fine wrinkling on, above, and below the lips
- Deepened nasolabial and marionette folds
- An elongated and flattened upper lip
- A diminished vermilion border
- Downturned mouth corners
- Deepened chin creases
- Skin irregularities
So, as you can see, it is a complex area. Lip filler alone cannot address all of the above.
My practice in Plettenberg Bay focuses on aesthetic treatments for patients in their golden years (50+), so I treat this area often. Unfortunately, I also see the results of various complications and incorrect treatments.
With my love for dermatology, I have a general rule in my practice and in how I manage patients: healthy skin and correct anatomy always come first!
Steps to treat the peri-oral area
So, what is the process of addressing this complex area, you may ask? In a nutshell, this is my advice:
- Book a skin consultation with a medical doctor you trust in your area.
- If you have problems stemming from your midface or dentition, it’s important to address these first. These two areas indirectly affect the peri-oral area and how we would treat it.
- Consider these three components of treatment:
- Peri-oral muscles: This is where we make use of botulinum toxin injections. This is an injectable treatment used to temporarily reduce muscle contraction and therefore wrinkles in the skin. There are three main muscles I inject in this area:
- Depressor angular oris muscle – this muscle pulls our mouth corners down, which becomes more prominent as we age.
- Mentalis muscle – in some patients, this muscle is overactive during talking and can contribute to excessive skin dimpling in the chin.
- Orbicularis oris muscle – I inject this muscle just above the upper lip border to relax the part of the muscle above the lip, resulting in the popular “lip flip”. This, in turn, reduces the barcode lines above the top lip. In no way will this make you look “overdone” – which is a real concern for many of my patients. It is a very subtle and worthwhile injection point to try.
- Peri-oral skin and fat pads: Here, I use a combination of injectable, skin resurfacing, and sculpting treatments. There are many, but these are a few of my favourites:
- Fine line filler into the barcode lines above and below the lips, as well as the lateral sleep and “personality” lines.
- If there is excessive skin and fat pad sagging, a discussion needs to be had around midface dermal fillers or biostimulators for a lifting effect. Face-lift surgery may be considered if this is too advanced.
- Tixel procedures to tighten and resurface the skin.
- Deep chemical peels such as the Elaine Brennan Skin Renewal Peeling System to resurface the skin.
- Morpheus 8 radiofrequency microneedling to tighten skin and remodel subcutaneous fat.
- Lips
- I agree to lip filler when it is anatomically acceptable to do so. Some patients have very thin lips, which benefit from being slowly filled over time to produce a slightly fuller look.
- Ageing lips do very well with small amounts of lip filler. Our aim is to provide a subtle volumisation, redefine and correct the diminishing lip border, and hydrate the lip tissue.
- Lip filler is best done in two sessions, 2–4 weeks apart, for natural-looking results.
- Peri-oral muscles: This is where we make use of botulinum toxin injections. This is an injectable treatment used to temporarily reduce muscle contraction and therefore wrinkles in the skin. There are three main muscles I inject in this area:
In closing
On a final note, it is important to remember that the peri-oral area is a dynamic one. While we have wonderful treatments that can definitely improve its appearance, there are age-related changes in this area that we simply have to learn to accept.
Let’s not let every laugh line get us down. Ageing is a privilege denied to many.
MBBCh (Wits) | Adv. Dip. Aesth. Med (SA)
Dr Michelle Hutton is a General Practitioner with a special interest in Dermatology and Aesthetic Medicine. She is the founder of Hutton Medical in Plettenberg Bay, which is a comprehensive destination medical and aesthetic centre servicing the Garden Route as well as local and international tourists.
Dr Hutton has a Medical Degree from the University of the Witwatersrand and has completed the Advanced Diploma in Aesthetic Medicine in South Africa. Her passion lies in skincare; she strives to make her patients feel confident in the skin they’re in. She has completed multiple private courses in Aesthetic medicine and has attended multiple local and international congresses so as to stay on top of advancements in the industry.
She is a wife to an avid cyclist, Kevin Evans, and a mother to two beautiful children. Outside the office, she is a keen runner, golfer, and half-skilled cyclist. With Plettenberg Bay being a small town, Hutton Medical has been aiming to provide a professional, high-quality, yet personalised service.