Why the central lower 1/3rd of the face ages


The central lower 1/3rd of the face is the area bordered by the base of the nose, superiorly, the chin, inferiorly and the right and left oral commissures (angles of the mouth).  Many initial consults are motivated by features, which are perceived as objectionable and these include: 1. perioral lipstick "bleed" lines; 2. loss of lip fullness; 3. change in shape of the lip posture; 4. nasolabial lines or folds which extend from the nasal base inferiorly; 5. "marionette's" lines, originating from the corner of the lips, downward; 6. prejowl sulcus (apparent "dents" in front of the jowls); 7. deepening of the labiomental groove (horizontal line above the chin); 8. "cobblestoning" or dimples over the chin and adjacent to it. Anatomy explains many of these findings.  Repetitive movements involved in chewing, puckering, grimacing and smiling require muscular action, which in turn etch wrinkles onto the overlying skin. Botox is used regularly in the brow to prevent wrinkles, however the dose typically used to temporarily soften the lipstick bleed and puppet lines must perforce be adjusted downwards, so as to not compromise the sphincteric function of the muscles.   The loss of fat in the lips, over the chin, overlying the canine teeth may be manifest as shadows or depressions; fillers may restore their contours. Bone recession in the jaw and teeth ultimately makes the framework less robust to support the soft tissue.  
Solutions usually require combination therapy: neuromuscular toxins, dermal fillers but can also include good skin care, gradual collagen stimulation (Pelleve, Ultherapy), silicone lip and/or cheek implants, chemical peels and laser resurfacing.  The choice of modalities is predicated on the patient's Fitzpatrick skin type, expectations, available down time, health.  Whether evaluating a newbie 40-something or incorporating full rejuvenation in tandem with a facelift, success depends on identifying the offending features, articulating solutions and implementing them with a gentle hand and measured aesthetic sense.  Overcorrection of any so called defect invariably upsets the balance and creates a cartoonish look, which are variably named "trout pout", puffer cheeks, etc.  In all things moderation.   
Article by
Orange County Plastic Surgeon