Authors are: Dr. Stephen Smith and Dr. Edwin F. Williams, III
Rejuvenation of the perioral area requires consideration of all three processes of aging: volume loss, ptosis, and skin changes.
Distinction between the midface and perioral region is not conspicuous, but rather the two regions are in continuum. The senior author commonly uses midface rhytidectomy to lift and relieve some of the changes related to ptosis and volume redistribution; however, this technique primarily affects the vertical component of ptosis along the jowl and may not completely address the perioral region. Therefore, a combined approach, involving multiple disciplines, is preferred. The techniques discussed can often be used in conjunction to obtain optimal results. For example, the down-turned oral commissure can be evaluated through chemodenervating the depressor anguli oris at the modiolu, whereas lipotransfer to this area can restore lost volume, creating a more natural, youthful result.
Of supreme importance, particularly when establishing a healthy, long-lasting, mutually content relationship with patients, is to verify the goals of treatment: safe, effective rejuvenation with realistic outcome ideals, using the most appropriate, valuable means possible. Although this practice may not attract the masses of patients seeking the cheapest, quickest fix, it will establish long-term patients who wish to obtain optimal, sustained results.
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