Comprehensive Surgical Aesthetic Enhancement and Rejuvenation of the Perioral Region

Abstract

There has been minimal attention paid in the literature to the aesthetics of the perioral area, either in youth or in senescence. Aging around the lips traditionally was thought to result from a combination of thinning skin surrounding the area, ptosis, and loss of volume in the lips. The atrophy of senescence was treated by adding volume to the lips and filling the deep nasolabial creases. There is now a growing appreciation for the role of volume enhancement in the perioral region and the sunken midface, as well as for dentition, in the resting and dynamic appearance of the perioral area (particularly in youth). In this article, the authors describe the senior author's (BG) preferred methods for aesthetic enhancement of the perioral region and his rejuvenative techniques developed over the past 28 years. The article describes the etiologies behind the dysmorphologies in this area and presents a problem-oriented algorithm for treating them.

Analysis and Classification of the Upper Lip Aesthetic Unit

“…Dental show represents another vital quantitative element. Although 2 mm is normal in younger patients, 11 we consider 1 mm acceptable in those older than 40 years. Assuming normal maxillary height, leptocheilos patients exhibit normal to excessive incisal show (type 1), whereas philtral redundancy veils dentition (types 2 and 3).…”

“…Review of the perioral literature revealed classification systems, rating scales, and surgical algorithms for filler placement, musculature, rhytides, reconstruction, and cosmetic modification of the lips and ergotrid separately. 3,6,11,[16][17][18][19][20][21][22] However, the labral classification system is the first to address the entire labrum.…”

Role of Autologous Fat Transfer to the Superficial Fat Compartments for Perioral Rejuvenation

“…15 With aging, the lips become thin and lose crispness in their white roll and philtral columns; the subcutaneous fat atrophies, highlighting the fine wrinkles. 16 The loss of lip volume and support is accentuated by increasing nasolabial fold depths and marionette lines. Treatment goals of perioral rejuvenation are directed toward reversing this process and restoring a more youthful appearance by lifting and filling the fat compartments.…”

“…Bioengineered fillers have been used quite successfully in soft-tissue perioral augmentation, 17,18 but complications may arise, including granulomas, nodule and cyst formation, and asymmetry. 16 Recent literature has suggested that autologous fat transfer to the deep compartments of the face is a powerful adjunct to volume restoration during rhytidectomy and an ideal autologous alternative to bioengineered fillers. 19 Rohrich et al reviewed 100 patients who underwent a face-lift procedure followed by fat grafting to the deep compartments.…”

“…Ideal perioral rejuvenation requires a lift and fill of the deflated space followed by possible resurfacing of any deep vertical rhytides. Various fillers and resurfacing agents have been successful in rejuvenating the superficial compartments in the perioral region 16 ; however, few studies have assessed the efficacy of autologous fat transfer to this area. The success of autologous fat transfer to the deep compartments has led us to hypothesize that volumetric manipulation of the superficial fat compartments with autologous fat transfer can enhance perioral aesthetics.…”