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Jack A. Friedland, James L. Baker, George W. Weston, Patricia Wexler, Perioral Rejuvenation, Aesthetic Surgery Journal, Volume 19, Issue 1, January 1999, Pages 57–64, https://doi.org/10.1016/S1090-820X(99)80010-7
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Dr. Friedland: The first patient is a 59-year-old woman with a sad-looking mouth, very small lips, and a downward slant of her oral commissures. She desires fuller lips. She doesn't have deep wrinkles or rhytids in the upper or lower lips or oral commissure. The nasolabial creases are not deep; the folds are not enlarged (Figure 1). Dr. Weston, how would you treat this patient?
Dr. Weston: She is just beginning to show age around the mouth in three typical ways. The first way is to droop or sag, the second is to wrinkle, and the third is to become thin or gaunt. This patient doesn't have much wrinkling, but she does have the drooping of the upper lip and the corners of the mouth.
To treat drooping of the mouth, some kind of lift procedure is performed that will require incisions or excisions. I would consider a lip lift excision underneath the nostril sill to lift the central portion of the lip, and a corner mouth lift to correct her unhappy look and downturned corners (Figure 2). I would use a technique that I described several years ago—a wraparound corner mouth lift that would not leave a scar outside of the vermilion—to bring the corners of her mouth up (Figure 3).
