Wrinkles Perioral / Mouth

What are the two types of wrinkles in the mouth area?

The two different types of wrinkling are-

• Static wrinkles: are present at rest, mostly due to smoking & sun damage.

• Dynamic wrinkles: are made worse with animation; think puckering.

In reality, most cases will have both elements, hence combination treatment is ideal.

Most patients will have a combination of dynamic & static wrinkling, hence in most cases the ideal treatment involves lasers & injectables.

Why do women have wrinkles & blokes do not?

Five reasons, & they are-

1. Men have facial hair; this acts as pylons of structural support in the dermis

2. The dermis in males is thicker than females

3. Facial hair protects from UV

4. Shaving is a form of collagen stimulation, akin to dermaplaning

5. Mimetic anatomy is different, females express more, talk more. Sorry.

What types of lasers do I use to treat perioral wrinkles?

Depending on the depth of static wrinkles, I use the following lasers.

• Fractional CO2 & thulium lasers: for superficial wrinkling & mild sun damage.

• Ablative Erbium & CO2 lasers; for deep wrinkling & smokers’ lines.

One session will give great results. If you have higher expectations, a second laser session is possible. Recovery ranges from 4-10 days.

Is laser resurfacing painful?

No. We use anaesthetic blocks & mild sedation to ensure comfort levels. Recovery following resurfacing is painless.

Is it advisable to treat the surrounding skin?

I do treat the surrounding areas with lasers. This gives a nice blend, reduces demarcation & hypopigmentation. The surrounding areas heal faster than the mouth area.

CO2 lasers can make a huge difference in only one session.

My usual practice is to use a fractional laser for blending, whilst I employ fully ablative erbium & CO2 lasers for deeper wrinkles around the mouth.

Can chemical peels treat perioral wrinkles?

Medium to deep peels can make a huge difference to perioral lines, including smoker’s lines. I employ Jessner TCA or regional phenol croton oil peels. Peels give less demarcation compared to deep CO2 fully ablative laser resurfacing. Downtime is approximately 7-10 days.

In some cases, I combine peels with fractional ablative lasers, for better results. This only extends the downtime by 24 to 48 hours.

How should you approach dynamic wrinkles?

Dynamic wrinkles are due to repeated muscle movement. Take some paper, keep folding it in one direction, notice the lines?

The same thing happens to the lips-especially upper lip. In some cases of hyperactivity we may combine lasers with injectables to help reduce movements.

If you have lines at rest, you will benefit from lasers.

Can dermal fillers reduce perioral wrinkles?

Dermal fillers can support the upper, lower & corner of your lips, in turn reducing wrinkles. I use both hyaluronic acid fillers & collagen stimulating calcium hydroxyapatite.

Fillers can directly fill the gaps or barcode lines, or they can be delivered to improve structural integrity. Fillers last between 9 to 18 months.

Ideally fillers are synergistic with laser resurfacing as both can increase collagen. Not all lips are suitable for dermal fillers as the aesthetics need to be respected. Patients with a tall or long upper lip to nose ratio are best treated with surgery & lasers. Fillers can exaggerate this ratio.

Can microneedling help perioral - mouth wrinkles?

Microneedling can be effective, but the downside is that it requires 3-9 sessions over a span of a year (Has anyone got that amount of free time? Seriously).

Adding controlled heating via radiofrequency can half the number of sessions required. Devices include Infini RFM, Genius RF, Morpheus 8, Intracel, Intensif & Secret RF. Personally, I think lasers are much more effective, however if you want RF microneedling, suggest this treatment during your consultation.

What are non-successful treatments for perioral / mouth wrinkles?

The three worse treatments include-

1. PRP, for dermatologists who don’t know how to use fillers. PRP is good for hair loss, but it does not work in the context of predictable results. It is an unnecessary add on.

2. Plasma pen; a sure way of developing lifelong scars.

3. LED lights for phototherapy, as seen in many beauty clinics. LEDs feel nice, that is about it. Total waste of time & money in the context of treating perioral wrinkles.

When is surgery indicated?

Surgery is useful in changing the upper lip to nose distance. Over time this distance increases as the lips migrate downward. Lip lift surgery corrects this distance, restoring a more pleasing ratio. In most cases I perform laser surgery on the same day. This generates collagen, further compounding the effects.

It is much more complex than just filler. Static lines respond well to deep peels or lasers. Injectables can modulate dynamic wrinkling. Surgical approach will correct the lip ratio, & provide natural (slight) upturning of the upper lip, bringing the whole area into proportion.

Recovery following surgery matches downtime from surgery, namely 7 to 9 days.

What anti-wrinkle creams are best in this area?

After sunscreen, your second layer of defence are antioxidants. These include ascorbic acid, tocopherol, silymarin, & ferulic acid.

To build collagen, retinoids including retinol, retinaldehyde & retinoic acid should be applied nightly, as tolerated. In general, the perioral area is more resilient compared to around the eyes, so irritation is less likely with powerful actives.

For advanced users of skin care, AHAs such as glycolic, lactic, & mandelic acid can be used as tolerated. My clinical team will discuss skin care with you post procedure & how to time the introduction of various ingredients.

What does a perioral wrinkle treatment program look like?

The program depends on the amount of wrinkling & contribution from muscles.

Examples are-

1. Mild To Moderate Perioral Wrinkles

Treat with: Thulium or Co2 laser, +/- Botox or Fillers

Maintain with: Retinoic acid & AHAs

1. Moderate to Severe Perioral Wrinkles

Treat with: Fully ablative CO2 laser, +/- collagen stimulating dermal fillers

Maintain with: Retinoic acid & AHAs, 1927 Clear & Brilliant Lasers.