Can Your Mouth Make You Look Older?

Can the appearance of your mouth make you look older? You’d better believe it can. Your lips and the perioral tissues (“peri” means “around” and oral refers to the mouth) age just like the rest of your face. There are different units within this area and each ages in a different way. Below, I will explain each.

The Lips: (aka, “red lip” because it has more visible blood flow) When I am referring to lips, what I have in mind is the “red lip” only.  This is the part that you put lipstick on.

Upper perioral skin:  This is the skin between the upper red lip and the nose.

Lower perioral skin:  This is the skin inferior to (underneath) the lower red lip.

Chin:  The area under the lower perioral skin.

The Lips: The ideal young upper lip shape is not straight across like a tube. There is a fullness far on the right (right lateral “pillow”), a fullness far on the left (left lateral “pillow”), and a central projection (which we call the central tubercle). The ideal lower lip has a fullness on the right but closer to the center than the one on the upper lip (lateral pillow), the same type of fullness on the left (lateral pillow), and a central depression or crease separating the two. The upper lip should NOT be as thick from top to bottom as the lower lip. The areas of fullness are produced by fat. Underneath the fat is muscle, but the muscle is flat and does not contribute to these hills and valleys. Over the fat is skin. The skin is supposed to have some creases in it (I underlined that because when people insist on over-inflating the lip, it will overcome the natural skin covering of the patient’s lip, stretch out the creases, and make the lip look like a sausage. I don’t recommend this because it looks unnatural.) The creases allow your lips flexibility to stretch as you speak, eat and smile.  As you age, you lose fat across your face. And, the lip is not protected from this event. Loss of fat from the lip makes the areas of fullness less plump and this leads to a flattening of the lip which is perceived by the casual onlooker as “harsh” or “not sumptuous” and “older”. Furthermore, if you were to compare photos of yourself at 20 and yourself at 50 (or 40), you would probably see that the creases or wrinkles in the red part of the lip are deeper and more apparent. The reason for this is the deflation of the lip from loss of fat (just like going from a grape to a raisin). Finally, those deeper wrinkles in the red lip often radiate out toward the white lip in the form of “smokers lines”.

Upper perioral skin: The muscle that makes the lips work is in the shape of a circle. When you tighten this muscle, you “purse” your lips because when the muscle contracts, it pulls all of the lip tissue in toward the center, making them smaller and tighter. Doing this activity countless times each day of your life creates folds in the skin that eventually produce permanent creases that radiate out like wheel spokes from the red lip out into the perioral skin. These are the wrinkles people refer to as “smoker’s lines”. Smokers do tend to have worse-than-average versions of this problem, but frankly, the problem still happens to everyone. The reason smokers get this worse is mostly due to the fact that years of smoking SIGNIFICANTLY affect the quality of the skin across the entire face, making it dry, dull, less springy, and therefore with more obvious creased wrinkles (not just because they frequently put their lips in “pout” position when they suck on a cigarette). Distinct peri-oral wrinkles are read by the on-looker as “older”.  Furthermore, there is a spot right in the middle of the upper perioral skin called the philtrum (see the picture). In the young, ideal lip, this is deep with sharp edges (the sharp edges are called the “philtral columns). In the older lip, it tends to get flatter. Flatter philtrum is read by the on-looker as “older”.   (See the photo above of the young mouth)

Lower Perioral Skin: This skin gets the same radiating wrinkles as the upper lip for the same reason. But a collection of other changes occur with this region. The corners of the mouth (oral commissures) tend to start pointing down with time and look deep. Over time, an actual wrinkle can extend directly from the corners of the mouth down onto the chin., I think it happens because you lose soft tissue support from the region of tissue just inferior to it (underneath it).  When you’re younger, you have more fat in this area and the tissues are springier (have more strength). This fuller region tends to support the corners of the mouth (called the oral commissures) and hold them up. In addition, there is a band of muscle that exists to pull the corners of the mouth down (the “DAO”, depressor anguli oris). Even if you don’t go around frowning, this muscle still exists and tries to do its job and eventually the power of the muscle and the effects of gravity which help it pull down is too strong for the soft tissues that help to hold it up. Loss of these soft tissues not only contributes to deep and down-pointing oral commissures but to a depression or hollowing the becomes the “marionette line”, and this that does not support a youthful look.

Chin: There is a depression that separates the chin from the lower perioral skin. If you’ll look in the mirror, you’ll instantly realize what I’m talking about. This depression (called the labiomental sulcus—“labio” refers to lip and “mentum” means chin and sulcus means a groove or furrow) sometimes becomes deeper and more pronounced with age. When this happens, it tends to produce a harsh look.

Next, just on either side of the chin people usually develop with time another depression that is an instant and undeniable sign of aging—the pre-jowl sulcus (see picture below). The “jowls” are the bulges against your jaw on the right and the left that seem to show themselves as the face “falls”. The shadow just in front of them is the pre-jowl sulcus.

Most people become familiar with the term “marionette lines”.  This is the line of shadow (that can eventually become a sharp crease) extending from the down-pointing corners of the mouth to the pre-jowl sulcus. Filler to address the marionette lines is one of the most common applications of filler.  When doing this, what you are addressing is the pre-jowl sulcus, the loss of volume underneath the corners of the mouth, and often the corners of the mouth (commissures) are treated at the same time.

Finally, the muscle underneath the central mound of the chin, when flexed, draws the skin of the chin in and forward. This muscle when over-used for years and years can create little dimples and irregular depressions in the chin.

If these changes happen early in life, then you will look older than you ought to. If they happen at the typical time, then reversing them can greatly add to a younger look. Every one of them can be addressed, most typically with injectable fillers (and a couple of these issues can be helped with Botox as well).

When I am treating the lips and perioral regions in an attempt to “turn back the clock”, my goal is to minimize wrinkles, replace lost volume, and erase shadows that are drawing attention and defining you as “older”. My goal is not to produce pouty “duck” lips although certainly the lips can be made more voluminous.  If you are interested in lip augmentation to produce lips that are bigger than your natural lips, then please see my description of that by following this link to understand what is achievable and what should be avoided.

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