Before and after minor surgical lip lift. COURTESY FINGER & ASSOCIATES

The areas that show age the most are the mouth and eye regions. Of course, if one has an obvious “turkey gobbler” neck or drooping jowls, these are problems too. This discussion is limited to the aging mouth, or the perioral area.

The “cutaneous upper lip” is the skin between the nose and the vermillion, the red part of the lip. The “marionettes lines” are the creases below the corners of the mouth. The nasolabial lines are those smile lines between the nose and the corners of the mouth.

As we age, the skin becomes thinner, and thin skin wrinkles more than thicker skin. The cutaneous upper lip gets longer vertically. Longer lips hide the teeth and actually turn under making the already thinner vermillion look even thinner.

Then, wrinkles occur in upper and lower lips, which everyone hates. The marionette lines come from thinner skin, loss of fat and the volume loss in the cheek mound, causing the cheek to sag.

How can we reverse this? First understand it might take several different treatments for the best result, and there will be maintenance. After all, your original flawless skin did age, and we hope to continue aging.

The newest CO2 fractionated laser is the Cartessa Deca laser which aggressively diminishes wrinkles, shortens the distance between the lip and nose, and also turns the lip outward making it look fuller. The next non-surgical treatment would be a filler or fat injected into each wrinkle as well as a layer to thicken the skin.

Lips themselves also get thinner, and can be injected with a long-lasting filler using a micro-cannula instead of a needle to assure smoothness and less bruising. Too much filler or injecting in the wrong area of the lip makes people look like ducks.

Additionally, a filler can be used to fill in the marionette crease. Some of the marionette line problem is from the sagging cheek, and this can be treated with fillers in the cheek, an InstaLift or with a facelift.

Surgical correction of a sagging cutaneous upper lip is removing a small strip of skin just under the nose. This scar fits in a natural crease and is difficult to see. It is done under local anesthesia. To turn the corners of the mouth up, a small procedure removes a triangle of tissue from just above the corners of the mouth raising it up according to how much is removed. The idea is to make the lips have a happy appearance.

Finally, Botox or Dysport can be used to weaken the muscles of the lips to help diminish the wrinkles and even raise the corner of the mouth. Using a combination of these procedures can diminish the appearance of the aging lips dramatically.

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