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07 September, 2023

Treating the Peri-Oral area by Dr Charné

Peri-oral Ageing 

Let us look at the ageing process that occurs at the peri-oral area and how we can treat it. 
 (Peri- around ;  oral - mouth)
The reason for speaking about this topic, is that it is one of  the most common complaints that patients bring into the consultation room.  
It is also one of the most common skin/ageing complaints for all patients above 50 years of age.
Patients mostly complain about fine lines and wrinkles around the mouth, “smoker” lines, drooping of mouth corners, and loss of volume in the lips itself.
I look at the mouth’s ageing process the same way I look at a dried prune. A prune that once was shiny and plump has shrunk, lost its water and hydration. And now we need to plump it up again and soak it in water. 
Why does all of the above happen?
1.     Well, from the age of 20 we lose 1% collagen per year.  Our skin loses elasticity and the extra cellular matrix in the dermis loses volume. 
2.     Now if you smoke or not, we all will get ‘smoker’ lines at some point due to the contraction of the muscles around the mouth as we speak and loss of support structure  around the mouth with loss of collagen in the skin. Genetics play a role in when ageing starts and in which areas in the face ageing accelerates in. 
3.     Weakness in the vermilion border also leads to the formation of fine lines around the mouth. 
4.     Drooping of mouth corners happen because of depressor anguli oris muscles, pulling down on the mouth corners, making it look droopy. 
5.     As with the rest of the face, we lose bone density, our fat pads shrink and slide down and we lose volume with time in this area. Therefore when we treat the mouth, it is always important to treat the chin and area above the lips as well. This is our support structure and by treating the volume loss around the mouth, we are already treating and improving the lips. 
6.     Dentures, teeth, overbite, underbite, retracted teeth, skew teeth might push on a lip and cause asymmetry as well. Dentition plays a big role in the way that the lips are formed and either protruded or retracted. 
So what do we do about all of this?
1.     Firstly we have to lay a foundation, if necessary. First work around the lips and here I like to use filler (JUVEDERM/VOLUMA) a strong lifting filler for structure and support.
2.     Treat the skin: loss of elasticity and collagen, that led to fine lines needs to be rejuvenated. My favourite skin rejuvenation treatment is Volite (JUVEDERM) : a skinbooster filler. Hyaloronic acid draws water and plumps the skin up. Volite also increases the number of Aquaporin 3's in the epidermis which is important for transport of water into the skin. Most of the time we have to ensure that the vermilion border is strengthened with a bit of filler/skinbooster as well. 
For poor skin quality around the mouth I also suggest resurfacing lasers. Erbium laser uses microchannels of heat to ablate the skin and stimulate collagen while resurfacing the skin.  Pixel uses plasma technology to peel the top layer of the skin and stimulate new collagen formation which is also great for treating acne scarring. 
3.     For muscle movement of depressor anguli oris (downward muscles of mouth corners) and mentalis muscle (muscle that pulls the chin up and makes little dots on the chin when contracted) anti-wrinkle injectable (BOTOX) can be used. Stopping the muscle from contracting will help lift the mouth corners and improve the skin quality of the chin.

4. And then lastly with the correct filler depending on the patient’s needs,  I will fill the lips itself as well if needed. This can range from restoring volume to just hydrating or correcting  asymmetry. 
Beautiful lips bring attractiveness and it is like the cherry on top of a beautiful cake. It brings beauty to the table and brings the final touch to a facial canvas. 
Treating the lips are important but more so is treating the causes of ageing and ensuring that the area around the lips are supported and treated as well. 
Dr Charné van Staden
Eden Medispa