Correction of the Aging

In the middle-aged patient, an elongated upper lip with loss of concavity, reduced vermilion, descent of the corner of the mouth and deep vertical wrinkles (code bars) show the real chronological age. The correction is performed by means of a complete skin undermining to the vermilion through a skin excision at the naso-labial junction and nostril base [20]. A trapezoidal graft of temporal subgaleal fascia is sutured at both naso-labial folds to cover the orbicularis oris muscle. An extra strip may be used to increase the thickness of the vermilion. The result is satisfactory and the incision, except for hypertrophic scarring, which is very rare, is unnoticeable after a few weeks (Figs. 41.11, 41.12). For correction of the descended corners of the mouth, which gives a "bitter" appearance, an additional suture catching the orbicularis at the corner and the base of the alae has also been effective.

Aesthetic Fascia

Fig. 41.11. Top: Trapezoidal graft of the subgaleal fascia and placement between the skin and the orbicularis oris muscle stabilized with two stitches at both naso-labial folds. Bottom:

The postoperative aspect shows increase of the vermilion, decrease of the flat upper lip, which becomes more concave, and correction of the deep wrinkles (codebars)

Fig. 41.11. Top: Trapezoidal graft of the subgaleal fascia and placement between the skin and the orbicularis oris muscle stabilized with two stitches at both naso-labial folds. Bottom:

Fig. 41.12. The vertical periocular and midface rhytidectomy with correction of the aging lip 1 year after surgery. The lateral view shows the decrease of the height of the lower eyelid, the elevation of the ptotic midface and correction of the contour flattening, to recover the fullness of the midface contour of youth by elevation of the ptotic tissues to their location decades before. The flat and long upper lip recovers its concavity with increase of the vermilion and decrease of height

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