Toronto - There are numerous procedures and techniques at the disposal of the surgeon for addressing the aging perioral features, according to Ross A. Clevens M.D., F.A.C.S., head plastic surgeon at The Center for Facial Cosmetic Surgery in Melbourne, Merritt Island, Fla. He discussed different techniques on how to best rejuvenate and sculpt the aging perioral complex region, at the American Academy of Facial Plastic and Reconstructive Surgery, here.
Dr. Clevens says, "The length of the upper lip, the position of the corners of the mouth, the laxity of the nasolabial folds, the shape and volume of the vermillion, as well as the degree of perioral wrinkling are just some of the aesthetic points to be dealt with when finding ideal solutions and gratifying aesthetic outcomes for my patients."
To better target and treat specific aesthetic areas, Dr. Clevens divides the face into three concentric rings:
"When I perform a direct lip lift, I leave a gap in the region of the pro-labium between the apices of Cupid´s bow. Then I make the strip twice as wide as the desired degree of advancement. Here, there is no need to undermine significantly. Then, as always, I finish up with a meticulous multiple layer closure. This method has consistently produced positive aesthetic results," Dr. Clevens explains.
He uses a corner of the lip lift when addressing the angry or bitter look of the downturned corner of the mouth, elevating the corner of the lip. His simple and very effective technique consists of a 12 mm to 16 mm incision along the vermillion-cutaneous border. He then draws a tangent to the lateral canthus or superior helix that extends 60 percent to 90 percent of the length from the corner of the lip to the nasolabial fold along the tangent. The result is a minimum degree of elevation of 3 mm. Dr. Clevens stresses not to over-undermine the tissue, and finishes with a meticulous multiple layer closure.
He opts for a subnasal lip lift, when intending to shorten the long upper lip of aging. This procedure allows the upper teeth to show again when the lips are slightly parted, effecting a more youthful look, he says. The major advantage with this procedure, he adds, is that the scar between the shadowed crease of the nostril sill and lip is virtually imperceptible. The disadvantage though, is that there is a central elevation of the upper lip, and the downturned corners of the mouth are not corrected.
"The aging nasolabial folds are not adequately improved by a facelift or a midface lift. In certain cases, I therefore like to perform a direct excision of the nasolabial folds for optimal cosmetic results as an alternative to a filler or a fascial graft at the time of face lift. In my technique, I place the incision just medial to the nasolabial fold, and begin and end the incision in a concavity rather than a convexity. Sometimes I find it sufficient to just excise the lower portion of the nasolabial fold. I then follow up a repair with a superolateral vector to achieve a lift of the commissure. This technique has proven itself time and time again to yield very positive cosmetic results," Dr. Clevens says.