Resurfacing and exfoliation

Fractional resurfacing treatments and chemical peels have also been recommended by our experts to treat the lines around the mouth. For long-term results, C02 lasers and TCA peels give excellent results. Less invasive treatments such as micro-dermabrasion, platelet-rich plasma (PRP) and fractional lasers can bring some good results, but a series of treatments is necessary.

Dr Sundaram uses a non-invasive chemical peel — Illumize Peel® by SkinMedica (An Allergan Company, Carlsbad, California) — a combination of alpha (AHAs) and beta hydroxy acids (BHAs), which work to improve the texture of the skin around the mouth. To treat brown spots and sunspots, a 1927 nm fractional erbium laser works well to lighten pigmentation and stimulate collagen production to address fine lines, according to Dr Brightman.

The panel of experts have different opinions on using exfoliating and resurfacing treatments, such as very light chemical peels or microdermabrasion directly on the red parts of the lip. As it is such delicate tissue, the lips need to be gently exfoliated and all the physicians opined that an at-home regimen might be best.

Micro-injections of HA to revitalise the lips seems to be a challenge. Dr Mariya Serheyeva likes to use them — especially with Juvéderm® Hydrate — for their antioxidant capacity, which prolongs the hydration effect. She also welcomes the fact that the treatment allows first-time patients to try lip enhancement without using bulking agents with cross-linked products. A lip-specific product,  part of the Restylane® skin-booster family — Restylane® Lip Refresh — will be phased out in April 2014, as business results were not in line with company expectations.

Home and office go hand-in-hand

The lips dry out faster than other skin and become chapped very easily. And according to Drs De Boulle and Serheyeva, dry and chapped lips age faster. The lips will shrink faster when constantly chapped: cracked lips lead to poor microcirculation and poor nutrition of the lip tissue, thus accelerating ageing.

All the experts interviewed agree on the use of the lip balm with an SPF 50, or at least SPF 30 all year round. It seems that by using a daily lip balm women could considerably slow down the ageing of the lips. However, they recommend steering clear of medicated and heavily fragranced lip balms as they contain highly irritating ingredients that are aggressive on the delicate lip skin. Lip balms containing phenol are another to avoid, as they can remove the natural protection of the lips and create a vicious circle of drying and chapping.

Lip exfoliation seems to be as important as moisturising the lips. Dr Zenker mentioned the use of a toothbrush to gently exfoliate the lips, and Dr Serheyeva advises her patients to use a scrub on their lips twice per week. She also suggests light chemical peels on the red part of the lips, with an AHA concentration up to 12% and a pH not lower than three.

Conclusions

The experts have also stressed the importance of advising patients to have any dental work done before treating their lips. Dental work can accelerate lip ageing, or even help to correct lip ageing if carried out by expert cosmetic dentists. When teeth are replaced, the lips shrink faster. Dentists can make the lips fuller in their work. When they replace old teeth with implants and prostheses, they can stop the jaw from receding. It’s like a balloon; if we inflate the balloon, the lips appear bigger.

The correction of the lip tone has not been addressed by cosmetic treatment yet. There are no solutions for this in the physician’s toolbox, although physicians like Dr Zenker work with semi‑permanent make-up artists to get the bright pink or red back into the lips. Fillers won’t get the bright colour back, so permanent make-up may be the way to do it.

And don’t forget, as Dr Adami  stressed, the lips are the focus of the lower third of the face. It’s important to keep educating patients that less is more — physicians should resist the patient always asking for a little more. They get used to the new normality and want more, and slowly they risk getting a ‘pillow look’.