Q. I am in my 50s, and my upper lip is disappearing. Is there anything I can do besides injections?

A. Actually, as we age, our upper lip (the skin between the red part and the nose) gets longer, sometimes considerably longer, to the point where upper teeth cannot be seen with the mouth slightly open, as they did when we were young. This causes the lip to turn under, making the mouth look older.

The treatment is a “buckhorn” excision of skin just below the nose. In youth the distance between the nose and vermillion (the red part of the lip) is 1.4 to 1.6 millimeters. Sometimes the distance increases with age, up to 2.5 mm. The buckhorn excision removes a measured amount of excess skin, and the scar is located just under the nose and is imperceptible. This procedure is done under local anesthesia.

Q. When I look in the mirror, I look sad or angry because the corners of my mouth turn down. Is there anything I can do about that?

A. The simplest treatment is to inject Botox or Dysport just below the corner of the mouth and in a specific place on the jawline. This relaxes the depressor anguli oris (DAO) muscle, which naturally pulls the corners down. This treatment lasts about 3 or 4 months.

When used with fillers, such as Restylane or Juvederm products (which last about 18 months), or Bellafill (which lasts about 5 years), the result is more lasting.

A permanent remedy is to excise a carefully measured triangle of skin just above the corners of the lip. This elevates the corners of the lip into a more “happy mouth.”

An alternative procedure, if the patient also has deep “marionette lines” (the crease below the corners of the mouth), is to extend the excision downward, also removing the excess skin lateral to the marionette line. This elevates the droopy mouth corners and reduces the deep marionette lines, and is also done under local anesthesia.

Injectable fillers can diminish marionette lines and, if needed, volumize the cheeks, jaw line, chin, or hollows under the lower eyelids. Fillers may be needed in addition to the minor surgical procedures mentioned since the questions above involve the aging face.

As the years pass, there is usually diminished volume of both fat and bone and replacement with fillers or one’s own fat is often indicated for the most optimal result.

Q. What is the treatment for earlobes when the pierced ear hole has enlarged too much?

A. Under local anesthesia, the edges of the hole must be cut out, generally through the lower border of the earlobe. Then, the open edges of the excision are sutured, closing the hole completely. The ears can then be re-pierced in about 6 weeks.

Q. My earlobes are thin, bigger, and droopy.

A. Like the upper lip, the earlobes get thinner and longer. Often a filler can be used to reinflate the earlobes. If this is inadequate, the excess earlobe can be excised.

E. Ronald Finger, MD, FACS is a board certified plastic surgeon with offices in Savannah and Bluffton. fingerandassociates.com