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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 22

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

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 46 reviews

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Facelift or Fillers?

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. 

Joshua L. Fox, MD
Long Island Dermatologic Surgeon
5.0 out of 5 stars 12 reviews

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

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


Ellen A. Mahony, MD
Westport Plastic Surgeon
5.0 out of 5 stars 13 reviews

Facelift or fillers?

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.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

Choosing Between Facelift or Fillers?

Thanks for the questions and thanks for including the photo as well – this helps. There have been a lot of great answers given to you thus far. I agree with those who have noted that you might be too young to have a facelift procedure, but that is always an option. I would tell you to make a consultation with a board-certified dermatologist or plastic surgeon in your area and learn what might be done when fillers, used appropriately; toxins, used appropriately; and certain RF skin tightening devices or Ultherapy, used appropriately, can do for your skin. You can get some very nice contouring, some nice volume enhancement, and make the difference you are looking for, without a surgical procedure.

Michael Gold, MD
Nashville Dermatologic Surgeon
4.5 out of 5 stars 10 reviews

Perioral area anti-aging procedures

Classically lifting from the periphery, like is done with facelifts, does not help the perioral area. Of course it would help if you could be assessed to determine if it is volume loss of the fat and bone that is accounting for your changes, or whether it's lines and wrinkles that are having the aging impact, which in that case, laser resurfacing would be the best treatment. Unfortunately, it is seldom that only one facet of the aging process is accounting for everything, which is why we have so many tools (ie: fillers, lasers, neuromodulators, surgery), so they can be combined to address the multiple facets of the aging face.

Sabrina Fabi, MD
San Diego Dermatologic Surgeon
5.0 out of 5 stars 38 reviews

Aging gracefully: Is surgery required?

Men and women considering a face lift at my Houston practice sometimes believe that the surgery is the only option that will address their cosmetic concerns.  While that’s true for some people, I think it’s important to remind my patients that there is no single option for facial rejuvenation that will suit everybody. Today, non-surgical injectable treatments can create beautiful, customized results without the downtime, risk, or expense associated with surgery.

These treatments, which include popular products such as BOTOX® Cosmetic, JUVÉDERM®, Restylane®, VOLUMA® and more, don’t just reduce wrinkles. They can also restore lost volume, which is an important and often overlooked component of facial aging. Adding fullness to the lips, cheeks, and other areas where it has faded over time creates a healthy-looking, youthful profile that subtly takes the years off. Although these treatments are temporary, lasting anywhere from 3 months to 2 years, they can be a big help to patients who wish to “try on” a rejuvenated face before committing to surgery.

When administered by an experienced medical professional who has a complex understanding of the anatomy of the face, injectable treatments are a comfortable, easy, and safe way to age gracefully on your own terms.  The best way to determine the best treatment plan for you would be to set up an in-person consultation with a board-certified plastic surgeon who specializes in facial rejuvenation. 

Camille Cash, MD
Houston Plastic Surgeon
5.0 out of 5 stars 13 reviews

Fillers first

Injectable fillers would be more effecting at addressing these wrinkles and lines. You can try it out and see if you like the results. A permanent solution with surgery can then be considered.

Facelift v. Fillers

Thank you for your question.

At 45, you might not be ready for the facelift club.  You can buy yourself some time by using a strategic combination of filler, perioral laser resurfacing and Botox.

To be sure what combination is best, see two or more board-certified providers in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have these treatments.

I hope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 51 reviews

Fillers to correct peri-oral area

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.

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.