Dr. Maas explains some lip enhancement options, including fillers, the corner of the mouth lip lift, sub-nasal lip lift, and how to get an optimal result.

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“I’ve had a lot of questions lately both in my clinic and online even a few phone calls about various ways to permanently or for the long term restore the area around the mouth, the aging lip and the problems or concerns have been expressed have been several.

The first thing that everyone thinks about now is using injectable fillers and I think they’re great products but they don’t always solve the problems that people present with. For example and we’ve talked about this before that this harmony between the length of the white lip here from the lower part of the nose and this whole areas are upper lip not just the pink part but from the lower part of your nose down to the vermillion, the pink part of the lip, and having a very narrow vermillion that’s addressed with what we call sub-nasal lip lift and some people use a direct lip advancement and I don’t favor that particular procedure as I’ve discussed before because it’s difficult to manage the scar and you lose the lip role, the white role that we think is very important in a natural lip.

Other questions, and I wanted to address this today include the corner of the mouth that appears to be downturn with age and this is common and more genetic but it accompanies descents of the cheek fat that’s going downward with gravity and then toward the lip and remember the lip includes the upper lip and the lower lip and includes the white portion of the lips. When that descent occurs, there is typically a marionette or little shadow line created here with a tissue heaping up on the outside or lateral part of that and along with that there can be quite a bit of hooding at the corner of the mouth where there’s really just a notch or little angular area coming down off the lip that people often describe again as a marionette line and its origin at the commeasure corner of the mouth.

Well, there are several procedures beyond just doing fillers that have been describe in the literature and all of them are very Asian so that we call a corner of the mouth lip lift and this is a minor procedure that can be done in the office, it takes probably 30 minutes and no more it is only a handful of very tiny little sutures so for most people with the types of starry strips in the skies that we use afterward people can go back to work afterward and have no one know that you had anything done.

When the recovery period occurs, we’re trading off a thoroughly extensive amount in some people of hooded skin over the outside part of their lip and the deep crack that goes downward typically for a very fine light line that extends out from the lip in one of the peri-oral around the mouth right at your wrinkle. So, it’s very hard to even identify the scar. This procedure is not offered to a lot of places and it’s sort of lost its way with the new fillers but I will say that for a long term correction for that type of lateral outside corner hooding of the mouth or downturn corner it is a fantastic procedure that offers people relief and complete resolution of this for the long term.

The procedure involves typically local anesthetic. We prep and clean the area very carefully as we do the procedure. There’s careful markings made and there are a couple of different versions of the procedure that have been describe by flowers and merlette. I’ll use both of them depending on the condition or the findings that we have in atomically at time or my own variation thereof and really it involves excising taking away a little bit of the tissue that’s redundant above the lip and then closing it in a very special way and we won’t get into detail with this but it’s a very precise closure that allows for that lip to be turned back slightly upright and then actually saddles back down to parallel over a few weeks. The procedure itself is with just local anesthesia or with you a little nervous will give patients a small oral anesthetic and as I said the recovery is not more than the 5 or 6 days we use for sutures and recovery is very simple without a lot of pain. Our satisfaction rate with this procedure is very high I’ve never had to revise that incision or the scar that’s made because it looks so nice afterward and so we’re talking about procedure that’s reliable and that’s consist that have been done for many years and one that may completely obviate the need for future use of fillers in that area.

Now, this can be done in conjunction with other procedures like the sub-nasal lip lift or the V to Y advancement of the lip and it can be done in conjunction with fillers. All these things can be done in combination to get the optimal lip. So, when we’re talking about lip enhancement the story doesn’t start and end with fillers it’s really fillers are one of the many tools we have as surgeons to get the ideal lip or should restore the youthful lip that is lost so commonly with volume loss and aging and the sagging of the tissues. If you have any questions about the corner of the mouth and lip lift, please don’t hesitate to call me, you can certainly send me photographs of your mouth in a closeup so that it’s a private and confidential or you can send your whole face if you’re willing to share it with everyone so they can learn. I can take that as a video or a photo, either way and show you what those results would look like in you. As always, it’s my pleasure this is Dr. Corey Maas on Looking Your Best”