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Facelift or Fillers? (photo)

I am only 45 and I hate the way my mouth and peri-oral area are aging. I feel like this area of my face makes me look 10 years older. My neck and jawline are still fairly decent so I'm not sure if its time for a facelift already or would a liquid facelift have a worthwhile effect on this area? Please advise, I'd like to take as many years off as possible in one procedure. Thanks!

Doctor Answers (17)

Central lower 1/3rd of the face is often the first zone to age

+2

Lilangelmommy: The perioral area is the 2nd most frequent area I treat, (after the upper 1/3rd/brow).  Your photos demonstrate good jaw and neck definition but also deflation of your cheeks, tension around the upper lipstick "bleed lines" and the beginning of a left mandibular jowl. Liquid facelift usually means the use of collagen stimulatory fillers (Sculptra, Radiesse) and both of these would be suitable for correcting the vertical lines or "fish gill" deformity, which many slender women in their 40's note.  Last century, a woman had to choose between optimizing either her face or her body, however now that the range of fillers has expanded, you can have both.  It has been estimated that you will need a bottle of Sculptra for each decade to produce full effect, however first you need to find a consultant to discuss your aesthetic objectives.  Sculptra's collagen stimulatory effects are slower to build but more sustained.  Radiesse gives almost instantaneous gratification, however less persistence.  The static radial lip lines confer a stern appearance, so the use of micro doses of Botox and Belotero would go a long way to softening and prettying your lips.  

Orange County Plastic Surgeon
5.0 out of 5 stars 30 reviews

Facelift or Fillers?

+2

Hi There,

You may certainly benefit from a facelift, but for someone like yourself with more concentrated wrinkles around the mouth, I would recommend a combination Pixel and fillers.  Pixel is a fractionated carbon dioxide laser that can help you achieve reduced wrinkles, create tighter skin and lead to a more even complexion with several days of downtime, depending on the amount of improvement desired.  We often add the Erbium laser at the same time to lessen or eliminate the peri-oral wrinkles and recreate the lip line.  Typically, only one treatment is necessary and results can be achieved with much less downtime than a traditional facelift procedure.  Fillers would help restore some of the volume you lost in the lower half of your face, which is part of the natural process of aging.  Of course, you would need an in-person evaluation by a physician to determine which procedure is right for you with the price being dependent on multiple factors including the type(s) of procedure(s) recommended, number of lasers needed, the size of the treatment area and the amount of improvement desired. 

Web reference: http://www.advanceddermatologypc.com/laser/pixel_co2_laser.html

Long Island Dermatologic Surgeon
5.0 out of 5 stars 8 reviews

The aging mouth...Lift v. Peel v. Volume...What to do?? Ask Dr Ellen

+2

Hello Lilangelmommy,

I can actually feel your pain, as I am in the same boat!  It's so frustrating to see your mouth slip away at a faster rate than the rest of you and it seems that there should be a simple solution to fix the problem without getting into a lot of surgery, etc.  And there are some remedies, so keep reading...

Here is my take on the perioral area:  Aging is a 3 Dimensional Problem-

1.  volume/soft tissue loss contributes to loss of lip projection and shape, our lips acquire a flatter appearance and the lip skin becomes more adherent to the underlying muscle

2  bone loss contributes to a more retrusive, prune- like or sucked in shape of the mouth.  The maxilla and mandible start to lose stock  and are less able to support the soft tissue.

3. loss of skin elasticity leads to drooping of the lips corners, a longer distance from the nostril to the free edge of the lip and more rigidity of the skin so that the vertical lines are more fixed and tight.

So you can see, there is not one simple answer to address this 3 dimensional problem.  And, as you can imagine, lifting from the sides won't be successful in directly correcting the lip/perioral region.

Based on what I've described of the aging process above, here are some tips that will help in the short term to soften the look of your lips and restore some of the femininity:

1.  add a little volume to your lips with a hyaluronic acid product- restore shape, add projection in cupid's bow

2.  I like to use a very small amount of Botox in both the upper and lower lip as well as the depressor muscle (pulls down the angle of the mouth) to reduce the muscle tightness a little bit.  This will soften the vertical ilnes and give the illusion of more lip volume and projection.

2.  microdermabrasion for the perioral area and chemical peel will soften the skin, make it more supple and pliable and able to retain moisture.

Regrettably, there is no 'silver bullet' for the perioral area and it requires a fair amount of attention to retain a soft feminine look.  However, it is a delicate region and proper care will go a long way to keeping a youthful appearance.

Thanks for asking!  Dr Ellen

ps:  in the future fat transfers could be combined with a face lift to add volume as well

 

Westport Plastic Surgeon
5.0 out of 5 stars 8 reviews

Facelift or fillers?

+2

From your pictures, I see three issues that cause aging to your mouth and lower cheek area.  First, there are some vertical lines on your upper and lower lips.  Second, there is an area on the sides of your cheeks where there is some volume loss.  Third, there is an area on both sides of your face, between the mouth and the area with the loss of volume on your cheeks, that has a bit of a protrusion.  A facelift, by itself, would only help with the third issue.  The vertical lines on your lips could potentially be helped with Botox or fillers, or a chemical peel or laser peel.  The volume loss on your cheeks could be helped with fillers, and generally filling that area would improve the area with the slight protrusion in front of it.  

San Francisco Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Fillers to correct peri-oral area

+1
Facial fillers such as Restylane can correct the peri-oral area very easily.  You may also benefit from Thermage which helps enormously with producing collagen and making the perioral/jowl area look younger as new collagen is formed.  It is essential to find a board certified dermatologist with experience in fillers and lasers for the best cosmetic results.
New York Dermatologist
5.0 out of 5 stars 23 reviews

Injectable Fillers

+1
Dear lilangel, thank you for your question. Injectable fillers can be used to enhance facial volume, correct lines and depressions, and rejuvenate the face without surgery. Some common fillers include restylane, juvederm, perlane, voluma, radiesse, and sculptra. Consult with a an experienced facial plastic surgeon injector to review your options. Good Luck!

Web reference: http://ljaesthetic.com/aesthetic-procedures-san-diego/injectable-fillers-san-diego/

San Diego Facial Plastic Surgeon
4.5 out of 5 stars 16 reviews

Facelift and fillers

+1

The patient clearly is volume depleted. Doing a facelift would only make you more bony-appearing and look skeletonized. Alternatively, if a surgical approach were desired, fat grafting would be the option. I do not think face lifting is an option if you want to look rejuvenated. In your case the ideal product to inject is Sculptra. This will give you volume as well as some skin thickening and has good longevity and if done properly can give a nice lift and rejuvenation. In addition, Botox can be used on the neckbands to improve areas of the neck. Ultherapy also can be helpful on the neck as a non-invasive treatment.

Web reference: http://www.chelseaeye.com/Liquid-Eye-Liquid-Facelift-New-York-City-NYC.html

New York Oculoplastic Surgeon
4.5 out of 5 stars 15 reviews

Facelifts VS Fillers

+1

Fraxel Re:pair or the CO2 laser can reduce the lines in the peri-oral and mouth area. Facelifts are essentially ineffective for improving peri-oral lines. Restylane or Belotero are effective injection treatments for fine lines around the lips.

New York Dermatologic Surgeon
4.5 out of 5 stars 30 reviews

Facelift or Fillers around mouth?

+1

Hey there!  You are correct that you really are not a candidate for a facelift yet, and fillers are likely your best bet.  Hyaluronic acid fillers like Restylane and Juvederm are very good at adding volume to the lips, marionette lines and nasolabial folds.  We also use them to add volume to the cheeks, which is sometimes called a "liquid facelift."  Laser resurfacing around your mouth would be helpful also for some tightening and smoothing of the fine lines.  Erbium or CO2 laser works the best in my experience.  The combination of volume addition and lasers is quite powerful.

Chattanooga Facial Plastic Surgeon
4.5 out of 5 stars 9 reviews

Would A Liquid Facelift Correct The Aging Around My Mouth?

+1

For your upper and lower lips, a liquid facelift to include fillers in your lips, usually Restylane, in the white rolled border between the red and white lip, Perlane to fill the body of the lips, and Belotero in the wrinkles (ritids) of the upper and lower lips. 

The wrinkles on either side of your mouth and onto the cheeks are due to a loss of collagen in the skin and also excessive skin.  Here, you will be best served by a standard lower facelift with the injectibles done at the same time.  A deep Supra SMAS facelift with SMAS plication will give you the best stretch on your loose skin and to get rid of the wrinkles on your cheeks.  

Starting approximately six weeks after your facelift, I would recommend a series of 3 Sculptra injections to give collagen back to the aging skin around your mouth and cheeks. 

You have a long distance between your lower lip and your chin, and your chin is beginning to sag which will lead to an unfortunate appearance known as a witch's chin.  This can be corrected once again by a liquid facelift using Radiesse or one of the HAs.  These fillers or a small chin implant will give the optical illusion of decreasing the height of what appears to be a very long face. 

As you can see, you need a combination of injectibles and surgery, and this can best be done by a Board Certified plastic surgeon who is a member of the American Society for Aesthetic Plastic Surgery. 
 

Honolulu Plastic Surgeon
5.0 out of 5 stars 159 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.