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Diagnosis: Atrophic changes of the mouth that occur with wisdom, maturity and good deeds (and also time, genetics and sun exposure)

Before

After


Oftentimes changes in facial anatomy and structure can occur with age, genetics, and environmental pollutants (such as cigarette smoke and alcohol) and sun exposure. Commonly when patients complain of having a “smoker’s mouth” or “smoker’s lines” around the mouth, they have actually never smoked, as was the case with this patient. The change is a matter of time, genetics and environmental exposures.

It can certainly have a dramatic effect on the self esteem of many of my patients.

Over time, the human body, especially the lower third of the face can lose volume. There is a natural balance between the production of hyaluronic acid, which is a supporting substance within skin cells and also a component in the lubricating fluid of the joints, and a natural breakdown in this substance. Over time, the enzymes that break it down remain fairly constant in their activity; however, the fibroblasts produce less hyaluronic acid, which results in a net loss of volume. Additionally, the orbicularis oris muscle running around the mouth will contract slightly over time, decreasing the surface area above it, like a closing accordion, accentuating the loss of volume, combining to produce lines around the mouth commonly known as “smoker’s lines” or “purseing lines.”

Often, my female patients will present for cosmetic treatments of the face, especially around the mouth, but not for augmentation, but purely for the “restoration to the normal look that they have enjoyed most of their lives”. In this particular case I restored the loss of volume with the filling agent Restylane (hyaluronic acid) and a very small amount of Botox Cosmetic to decrease the muscular contraction around the mouth (orbicularis oris) to restore a more natural appearing look of her lips, with excellent results. At this point, she will only require touch-up treatments approximately once per year.

As depicted in the before and after photographs, the patient was very satisfied with the results and reports that, in addition to her lips, her self esteem was restored, too.





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