Perioral Rejuvenation

The perioral region is second to the periorbital area in making a person appear tired, sad, happy, or healthy. Although a lot of emphasis has been given to improving the periorbital area, the perioral region has received less attention. The mainstay of addressing the perioral region is using fillers, mainly synthetic ones, to smooth rhytides and restore lost volume. Skin resurfacing is a second-line approach, in part due to the required 5 to 7 days of recovery time to heal. However, as we have learned through many other procedures, it is wrong to make one modality your hammer and every patient your nail.

In an article published online on November 20, 2014, in Aesthetic Plastic Surgery, Penna et al conducted a morphometric review of 462 perioral photographs to come up with a 2-dimensional classification system to evaluate the perioral region. The classification was based on 2 qualities: lip shape and surface changes. Lip shape was classified as (1) short concave upper lip with 2 to 3 mm of upper incisors visible and prominent everted vermilion; (2) moderately elongated and straight upper lip with upper incisors at the lower border of the upper lip and mild degree of vermilion inversion; and (3) strongly elongated upper lip that forms a convex curve around the frontal teeth row with upper incisors that are not visible and vermilion is inverted. Lip surface was classified as (1) distinct philtral columns, Cupid’s bow and white roll without static radial wrinkles, and minor dynamic radial wrinkles; (2) flattened philtral columns and Cupid’s bow, indistinct white roll, beginning static radial wrinkles, and strong dynamic radial wrinkles; and (3) invisible philtral columns, Cupid’s bow and white roll, and considerable static radial wrinkles.

This scale was validated for objectivity, interevaluator reliability, intraevaluator reliability, and reproducibility by having 3 plastic surgeons evaluate perioral photographs of 42 female patients. The scale proved to be valid to a significant degree using Cohen’s κ coefficient. Based on this evaluation scale, one can evaluate the anatomic structure of the lip to decide if no treatment is needed, if synthetic or autologous fillers would suffice, or if a surgical lip-lift is required. Furthermore, surface changes can help determine if no treatment is needed, if skin resurfacing is indicated, or if both skin resurfacing and volumizing is required. The authors studied female subjects because they constitute the majority of patients seeking perioral rejuvenation.

What’s the issue?

Certainly the field of noninvasive cosmetic procedures continues to grow yearly; however, one must temper the enthusiasm of the patient at times so that he/she does not undergo excessive procedures and end up with unnatural results. Furthermore, one must not neglect the importance of artistry and proper patient evaluation in order to achieve a natural rejuvenated appearance. For example, relying solely on fillers to address perioral aging has resulted in an astonishing number of celebrities and patients walking around with an unnatural and distorted appearance. In many instances, this look may age a patient rather than rejuvenate him/her. Cosmetic dermatology is a balance between knowing when to treat, how much to treat, and when to effectively combine modalities to ensure the best outcome. This classification system will be useful for training residents and newly graduated dermatologists.

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