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 27

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

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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 35 reviews

Facelift or fillers?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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
4.5 out of 5 stars 18 reviews

Candidate for Non-Surgical Treatment

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Hi Lilangelmommy!

You're certainly not alone, as ageing changes in this area are common. These include a loss of volume and definition of the lips, appearance of radial lines around the mouth, loss of elasticity in the skin and development of heavy nasolabial and marionette lines (though fortunately in your case these are not a prominent feature). Given that you have minimal excess skin present you would be a candidate for non-surgical treatment. Options that may be relevant for you include:

  • Filler - to restore lost volume & definition to the lips, plus possibly restoring any midface (cheek) volume that has been lost. Midface volume restoration helps provide a 'scaffold' for the tissues of the lower face to be suspended from.
  • Muscle relaxants - to minimise fine radial lines around the mouth and help turn the corners of the mouth upward, creating a more youthful lip appearance.
  • Skin-tightening treatments - including options for microdermabrasion, chemical peels, laser resurfacing, needling/mesotherapy or injectable collagen-stimulating substances.

Keep in mind that whilst you are a great candidate for non-surgical intervention, the results seen with these procedures are not usually permanent and will require ongoing maintenance treatments. You are possibly also a candidate for one of the many variants of a mini-facelift, though skin tightening treatments (and possibly muscle relaxants) will likely need to be undertaken in conjunction for best results.

I recommend consulting with a local, reputable aesthetic practitioner (plastic surgeon, aesthetic dermatologist or aesthetic physician) so that they can perform an examination, make a thorough assessment of your individual anatomy and provide further guidance (including discussion of realistic treatment outcomes) to help you make any treatment decisions.

Hope that helps!

Dr Scott.

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

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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.  

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 58 reviews

Concept Facelift Under Local Anaesthetic

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for your question and pictures. Like many of my patients, there is loose, sagging skin creating the appearance of jowls therefore you would be a good candidate for a local anaesthetic Concept™ Facelift Surgery. This type of Rhytidectomy is unique as the facelift is performed under local anaesthetic, and is less invasive than traditional methods, meaning the cosmetic surgery has a significantly faster recovery time, reducing the bruising and downtime of your recovery, from months to a matter of days.  

Please seek out a board certified plastic surgeon to have a private consultation with to discuss desired and achievable results, see before and after pictures of past patients and ask questions.  

Liquid Facelift May Not Be the Answer, But A Facelift May Be

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Though I wouldn’t recommend a liquid facelift, there are certain types of minimally invasive facelift procedures that can aid with mouth and facial wrinkles. For instance, the HourLift procedure can help easily remove mouth wrinkles with just a small incision in front of the ear, and then an hour long procedure. This procedure results in a more youthful and wrinkle-free appearance, all with minimal discomfort and a quick recovery time (sutures from the procedure will be removed after 6-8 days).

Eric Seiger, DO
Fenton Dermatologist
5.0 out of 5 stars 27 reviews

Facelift or Fillers?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for your question. You may benifit well from a fat transfer to your face to refill volume. This can often be done awake with minimal down time. Consult with a Board Certified Plastic Surgeon for a treatment plan that is best for you.

Choosing Between Facelift or Fillers?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
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
3.9 out of 5 stars 17 reviews

Perioral area anti-aging procedures

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
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 91 reviews

Aging gracefully: Is surgery required?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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
4.9 out of 5 stars 36 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.