Suggested treatment for wrinkles and loose skin around my mouth area? (photos)

Hi! I'm a 46 yr old woman who is 8 yrs post gastric bypass. Can the wrinkles & loose skin around my mouth be "fixed"? Also looking to smooth out skin around chin area. Really appreciate your opinion. And yes - I'll be sure to consult with a board certified plastic surgeon as well - I'm just confused by all of the conflicting information (juvederm, Botox, topical cream, laser, mini-face lift) and would love your input! Thank you!

Doctor Answers 32

Rejuvenation of mouth area is an ongoing endeavor

Hi Sook123.  Thanks for sharing photos.  Wrinkles & loose skin will look better if you restore dermal volume and thickness.  Profound radiofrequency microneedling increases collagen, elastin and hyaluronic acid.  A single treatment, completed under local anesthesia, can yield dramatic improvement with about 5 days downtime (redness, bruising, etc). The thicker your skin, the less likely it will sag, or wrinkle with muscle movement.  Yes, Botox can soften the muscle induced wrinkling and Juvederm injections can fill in hyaluronic acid gel into the wrinkles to immediately plump them. Topical retinA is irritating around the mouth, but a good stimulus for collagen production. All of these are either temporary, minimally invasive with little downtime, and/or need to be repeated throughout the year. Lasers, like chemical peels, will help increase collagen production by removing the top layers of skin. The Profound, CO2 lasers and TCA peels are all much deeper treatments that carry downtime, yield noticeable early results, and usually are not repeated frequently/within one year.  Generally speaking, the mouth skin is subject to continued movement and easily wrinkled, so there is no one and done treatment-even with a more aggressive treatment, you will still need to maintain your result with continued care.  Hope some of these differentiating points help you!

Treatment options for loose skin & wrinkles

I personally always think it smart to start with the least invasive options first which would be a combination of Botox, fillers and possibly laser. However, you need to have a frank conversation with your surgeon about your expectations. A non-surgical facelift can do wonders to rejuvenate the face, but once the skin hits a certain level of laxity, a surgical facelift is going to be a better option.

Kindly,

Kouros Azar

Kouros Azar, MD
Thousand Oaks Plastic Surgeon
4.8 out of 5 stars 21 reviews

Many options available!

I would start by recommending low dose botox or dysport to the upper lip to reduce the activity of the muscle around the mouth that causes those wrinkles.  Then laser resurfacing of the area will smooth and tighten the skin.  Finally, injections of the hyaluronic acid product, Restylane Silk at the border of the lips will give your lips definistion (not make them large) and the product will flow into the lines left to erase them.

Marisa Lawrence, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 39 reviews

Treatment of wrinkles and loose skin around mouth

If your main goal is to improve the wrinkles and skin around your mouth, there are a few treatment options.  Botox can help to improve some of the vertical lines above and below your lips.  Laser resurfacing or a chemical peel could also be used to help improve the wrinkles.  Another option would be Fractora, which is a radio frequency device that can help smooth out wrinkles as well.  A facelift can help address loose skin on the lower face and the neck, but it would not improve the wrinkles around the mouth.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

Treatment Options for the Lower Face

During your #consultation, your skin texture and elasticity, as well as your underlying skin structure and your facial bone structure will be evaluated. Based on this evaluation, your board certified plastic surgeons will create a custom surgical plan, detailing specific techniques and recommendations to meet your goals. In doing so, he or she should be sure to have a full understanding of what results you expect.

If you are not a #candidate, your surgeon can make other suggestions to address your concerns and objectives.
Patients who desire facial rejuvenation that is affordable, quick, and effective should consider the Lite-lift™. Like the Life-Style™ facelift, this is a modified facelift that can be performed in the office with a local anesthetic and improve signs of aging around the neck, jawbone and lower face. These procedures are not "Thread-lifts" or "String-lifts". We do not use the "barbed" sutures employed in these other lifting operations. The Lite-lift™ uses longer lasting techniques that are discussed below. Because the incisions are limited, there is less bruising, swelling and healing time for most patients. Many patients can be back to work in one to two weeks looking rested and more youthful.
The best candidates for #LiteLift are non-smoking patients 35-60 years old with early changes of the lower face and the neck. But whose skin has elasticity with well defined bone structure. Older patients who cannot or do not wish to have a longer operation or general anesthetic may also be a candidate for a Lite Lift™.

It is also possible to #combine #surgeries. In fact, I commonly recommend other procedures to go accompany a facelift, such as blepharoplasty or a midface (cheek) lift, to name a few. The combination of multiple of facial procedures may create an optimal result.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 96 reviews

Mouth wrinkles

Thank you for your questions and photos.  As some of the other surgeons stated the treatment for this can be multi faceted.  Botox will temporarily paralyze the muscles that create the vertical lip lines and fillers like Juvederm will plump up the line to decrease the appearance of the wrinkle.  Fractionated CO2 laser resurfacing is probably the most aggressive treatment which I feel yields the best results but there is downtime of several weeks (redness, oozing first week). You can also do Ultherapy with 1.5mm transducer to target collagen stimulation.  Lastly microneedling procedures works well with stimulating collagen.  Often it is a combination of aforementioned that yields the best results. Best of luck to you

Milind K. Ambe, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 36 reviews

Loose Skin and Wrinkles around the mouth after Weight Loss

My congratulations to you for your commitment to looking after yourself and addressing your weight with gastric bypass surgery.  As far as the issues you are facing around your mouth area, there are non-surgical treatments available for you to try first.  

I would suggest Botox above your top lip to address the vertical lines and filler around you mouth area to help give you some volume.  You may also want to try a laser treatment to help address the deeper lines.  If, at this point you are not seeing the results you want, I would suggest a consultation with a plastic surgeon to determine if you are a candidate for a lower-lift.

Hope this helps.

Dr. Philip Solomon

Philip Solomon, MD, FRCS
Toronto Facial Plastic Surgeon
4.3 out of 5 stars 84 reviews

Gastric Bypass with Significant Weight Loss Often Require Combinations of Treatments for Optimal Results

First of all congratulations on your weight loss. Significant weight loss often results in loss of volume in areas where this is desireable (e.g. abdomen, thighs, etc.), but also in areas where volume loss is more problematic (e.g. face).  Loss of volume in the face can lead to wrinkles, jowling and a more aged appearance.  

Filler and/or fat grafting can increase volume for lips, cheeks and nasolabial folds, but jowling is best approached with a lifting procedure with or without fat grafting/filler.  Mild jowling can be improved with Ultherapy (Ulthera), but all jowls are best improved with a facelift or necklift procedure.  

Specifically for your lips, filler can improve the vertical lines that are visible. The jowling can be improved with either Ultherapy or facelift (mini or full depending on the characteristics of your facial skin and SMAS).

Best of luck!

Dr.  Miranda

Facelift

Thank you for your question. A facelift can address creases along the nose to the mouth edges as well as remove loose skin from under the chin and jaw line. I suggest that you move forward and consult with a board certified facial plastic surgeon to learn more about the cost, process, recovery and results. 

Best wishes,

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 96 reviews

Facelift

while a facelift can be very helpful for loose skin under the chin and along the jawline, it really does very little for fine lines and creases around the mouth. The two best options for this are injectable fillers and laser resurfacing.

Fillers provide a minimal downtime, but temporary solution. Laser resurfacing requires time off, but provides a long term correction.  I would recommend consulting with a facial plastic surgeon, someone who focuses on facial rejuvenation to begin the process- best of luck!

Mark Hamilton, MD
Indianapolis Facial Plastic Surgeon
4.9 out of 5 stars 38 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.