article | TreATIng The lIps |
commissure. These fibres make up the deep muscle stratum of the lips.
Vertical lip wrinkles The improvement of radial wrinkles of the lips, close to the mouth edge, is the main goal of treatment. These perioral rhytides appear differently depending on the age of the patient; a premature appearance of these wrinkles is fundamentally a result of hyperactivity of the orbicularis oris (Figure 2), often associated with a constitutional lassitude of the same muscle. These ‘dynamic wrinkles’ appear only during muscular contraction. In these patients, the use of botulinum toxin A is often enough for good results (first patient cohort). In older people, however, the wrinkles are constantly
the patients want to improve the volume of the lips. In
the older patient, the toxin will improve the aesthetic result but, more importantly, it will extend the duration. In fact, one of the limitations of the resorbable materials in lip treatment is precisely the duration of the result owing to the constant mobility of this region2,3,5–7
.
Anatomy It is important to briefly review the anatomy of the lip, specifically the muscles responsible for forming barcode wrinkles. The orbicularis oris is the sphincter muscle that closes the mouth; it is located very close to the surface, near the mouth’s edge (Figure 1). It is not a single muscle, but its fibres derive from many other facial muscles. Orbicularis oris fibres are responsible for the barcode wrinkles (red fibres in the Figure 1). Then there is a superficial/medium layer, which terminates in the depressor anguli oris (triangularis) from the upper lip, and from the lower lip to the levator anguli oris1, 8
. The
buccinator muscle lies in a deeper layer; the fibres of the inferior lip derive from the superior part of the buccinator in the cheeks, and those of the superior lip derive from the inferior part of the buccinator at the cheeks. All fibres intersect at the mouth’s
Figure 1 Muscle structures surrounding the mouth
visible and become more pronounced during lip movements (Figure 3). In these patients the orbicularis oris hypermotility is connected with a reduction in lip fullness4, 8–10
and so, the use of fillers will be indicated.
Materials and methods In the period from January 2008 until May 2010, the author treated 180 female patients for upper and inferior lip wrinkling. All patients had a hyperfunctional movement of the perioral muscles, with the appearance of barcode wrinkles, and for this very reason were treated with botulinum toxin A. however, 106 patients also showed a reduction of lip fullness and for this reason they were also treated with hyaluronic acid. This resulted in two patient cohorts: ■ The first group of 74 (41.2%) patients were treated with botulinum toxin A alone, when only hyperfunctional movement was present without a reduction in lip fullness ■ The second group of 106 (58.8%) patients were treated with botulinum toxin A and hyaluronic acid in combination, as over the dynamic component there was also a reduction in lip fullness. The all-female patient group ranged in age from
30–68 years, with an average age of 43 years. no patients with pregnancy, coagulopathy, or neuromuscular disease were treated7, 9
. seven patients were taking ticlopidine the orbicularis
oris is the sphincter muscle that closes the mouth; it is located very close to the surface, near the mouth’s edge . it is not a single muscle, but its fibres derive from many other facial muscles.
Figure 2 Premature perioral rhytides in a young patient 32 ❚ October 2011 |
prime-journal.com Figure 3 Perioral rhytides in an older patient
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