Management of Lips / Mouth Area: Luscious lips are a feature of signature photos in every fashion magazine.  Not everyone is blessed with a pair of perfect lips.  The few who are don’t get to keep them forever without a little help.  The lip region serve as a barometer of both chronological and environment age.  The aging and wrinkling of the lip zone are influenced by at least four negative factors: accumulated sun exposure, genetics, smoking, and the natural aging process.

WHAT ARE MY TREATMENT OPTIONS?

1. Fine Lines/ Loss of the lip lines – lipstick bleeding zones:

The degree of wrinkling and loss of your lip lines determine which treatment choices you will have.  The approach to restoring your lips is never a “home run” treatment (one therapy) for most patients.  Until recently the most frequently used material for facial wrinkles including fine lines around the lips has been injectable collagen.  During the past four years other injectable products have replaced collagen that are smoother, softer, last much longer, and do not require a skin test.  These synthetic biodegradable hyaluronic acid materials are made by several different companies.

HOW DO INJECTABLES WORK? 
Restylane Fine Lines, Restylane, Perlane and Hylaform products contain hyaluronic acid in the form of a crystal – clear gel.  They are injected into the skin to lift the lip, wrinkle, or fold. Once in your skin they create volume, resulting in a healthy and vital appearance.  In contrast to other biodegradable implants, Restylane products are not extracted from animals.  This means no risk of allergy reactions.  Therefore, they are safe to use instantly without pre-testing.

HOW WILL I LOOK AFTER MY TREATMENT?
Treatments are done with a very tiny needle used for fine lines around the lips.  The new topical anesthetics like Emla-Max make this a  comfortable procedure.  Following the treatments normal activities can be resumed immediately. Treatment sites may have a little swelling that will last for a few hours.  Some slight bruising can be covered with makeup.  This maintenance project requires repeat treatments depending on your lifestyle and your goals.  Treatment is usually done at six weeks apart for two treatments and then the touch ups are done at four to eight month intervals depending on the age group and the degree of wrinkling.

The nice thing about these products is that you can replenish your lip lines whenever you feel the need.  Unlike permanent implants, Restylane or equivalent always leave you a choice when the effective treatment has worn off. A touch up can be performed any time you would like after the previous treatment.

2. Softening of the folds around the mouth area.

The degree of wrinkling in the mouth area gradually increases with time and those that have severe folds in the mouth area look much older.  Those that have these folds and wrinkles treated, have a softer, smoother look to their face.  These lines around the mouth are treated with injectable – filler products like Restylane, Perlane, Artecoll, Hylaform Plus and Silikon 1000.  The folds can be treated with Perlane at the base and Restylane Fine Lines at the top – shallower.  Six weeks later more permanent products can be used giving a longer lasting effect.  Artecoll or equivalent at a minimum of twice at approximately four months apart.  Some patients request more perfect treatments and will require more injections over time.  Following treatment normal activities can be resumed.  Discomfort is minimal and cosmetics can be used immediately after.  There is usually a very subtle bruising and irritation. There is some lumpiness and swelling to the area that can be felt but not seen. This will eventually blend, mold, and dissipate into the surrounding skin.

3. Upper and lower lip enhancement.

Lip enhancement is one of the most frequently requested cosmetic procedures at our centre. The approach requires a program much like climbing steps on a ladder. If you are willing to follow these steps the results are excellent.  The aim is to enhance your lips and to re-establish the soft fullness of the lip.  Blowing the lips up like a bicycle tire is a poor choice as the whole approach to enhancement is an artistic one to create full luscious lips that match your lifestyle, goals and your age group.

TREATMENT CHOICES
The injectable market has expanded to include many options. During the last four years I have not used Collagen products because the newer choices are smoother, longer lasting and stimulate your own collagen, giving long term results.  It is important to start with temporary fillers to make sure as a patient you like the concept plus it allows the tissue to expand smoothly and for you and others to adapt to your new lips.  Successful lip enhancement depends on understanding the proper lip anatomy. The technique is performed at my centre on a daily basis using regional anesthetic blocks like your dentist so you do not feel the actual treatment. It is important to match your upper and lower lip and create some harmony avoiding the duck bill look to the upper lip. The process is technique dependent and requires careful planning for me as the physician and you as a patient. The first treatment involves the use of Perlane or equivalent and then four to six weeks later the more permanent products are done at approximately four months apart for a minimum of two treatments or until you have the lips that you have anticipated.  Some patients still prefer Perlane twice a year so they can choose when to re-treat and how much. This latter option does allow us to create smoother lips without the risk of lumpiness sometimes associated with more permanent material.

Botox

• The tendency for droppy corners of the mouth increase with time.  This “SULKY” look with the down turned mouth can be greatly improved by minute quantities of Botox and injectables – fillers.  The horizontal crease across the upper lip starts in the 30’s and increases with smiling, animation, and age.  Tiny amounts of Botox is an excellent treatment option as fillers by themselves have been disappointing.  These clever Botox treatments create a softer smoother look to your face.
• Those patients that show their gums when animated, smiling, and laughing often find this feature unattractive.  The gums show increasingly with time and costly dental procedures really do not alter this look.  The accurate use of tiny amounts of Botox in the upper lip, which is almost painless, can dramatically relax the lip just enough to eliminate the gums showing without interfering with the lip function. The only negative feature is in those who play a musical instrument then the very subtleties of musical tones might be interfered with. Other than that this is not usually a challenge.

4. Rejuvenation of perioral lip zone.

Patients with more exaggerated wrinkles and loss of the lip lines require more assertive therapy such as resurfacing with the newer UltraPulse CO₂ Encore laser combined with the Erbium Yag laser. The “Remington Lip” is a combination treatment to improve texture, tone, and re-establish the lip lines and the Cupid’s bow area (the centre part of the lip).  Great  improvement is expected; however  a few patients may require injectables for the nasolabial folds.  Some fine lines may not quite disappear and some require a lip enhancement along with their rejuvenation of the wrinkles.  Injectables can be used for persistent folds, wrinkles, and lip enhancement three to six months after the resurfacing has been done. “Whatever it takes” to give you the best end result.

“We get the Artistic Satisfaction and you get your lips back”.