Sagging skin and wrinkles in the lower face are common complaints among cosmetic patients. Board-certified dermatologist Kimberly Butterwick, MD, of Cosmetic Laser Dermatology addressed those concerns in her recent webinar titled “Wrinkles and Sagging around the Mouth.” During the presentation, Dr. Butterwick explained these changes are part of the aging process as well as the potential solutions patients have for treating this area.
Cosmetic Laser Dermatology offers custom treatment plans for a wide range of skin concerns. Always on the forefront of the latest cosmetic treatments and laser research, the expert team offers the most innovative treatments coupled with the highest level of patient care. When you choose Cosmetic Laser Dermatology, you can rest assured our physicians are equipped to help you look and feel your absolute best through every season of life.
How the Lower Face Ages
Aging is a multi-faceted process that occurs on various levels of the skin, according to Dr. Butterwick, creating the need for a comprehensive treatment plan. With more than 50 laser and light devices, as well as a full menu of injectable treatments, Cosmetic Laser Dermatology is uniquely positioned to address a myriad of concerns in a single treatment session or a series of appointments.
Surface changes
These are the changes that are most noticeable because they occur on the epidermis (the outer skin layer) Common surface changes might include:
- Pigmentation changes (appearance of brown spots and patches)
- Texture irregularities from rough skin and enlarged pores
- Fine wrinkling around the nose, mouth, and chin
Subsurface Changes
These changes occur deeper in the dermal structure and require a different tool set to address. Some of the changes developing under the skin’s surface might include:
- Deeper folds and skin laxity due to volume loss and collagen depletion
- Contour changes caused by loss of bone, fat, and muscle
- Redistribution of volume as weakening of supporting framework leads to downward sagging
Treatment Options for Surface Wrinkles
Dr. Butterwick discussed etched-in lines in more detail, as they are one of the most challenging of all cosmetic concerns to treat. These are the small lines that are often found around the perioral area (located just above the upper lip). These wrinkles form near the skin’s surface and can also include smile lines and horizontal lines around the mouth and chin. Lines around the mouth often form and worsen faster than lines in the rest of the face.
Etched-in lines can be the result of repetitive facial expressions, or activities such as smoking or drinking through a straw. The unique structure of the mouth and teeth can also contribute to the line formation, as well as environmental factors like pollution and cigarette smoke. Photodamage, which occurs with repeated sun exposure, is the most common culprit as the powerful UV rays can damage the collagen and elastin fibers within the dermal structure.
Laser Treatments
Dr. Butterwick often recommends laser resurfacing for etched-in lines, although she emphasized that consultation, evaluation, and an exam treatment plan can vary somewhat from patient to patient. Options for laser treatments include:
- Non-ablative fractional lasers like Fraxel Restore that set at a more aggressive setting for fine lines will require a series of treatments to produce the best possible results
- Microablative fractional, such as the Clear+Brilliant laser, to treat brown spots and texture irregularities. This is a no-downtime laser that’s great for yearly maintenance of the skin
- Ablative fractional CO2 or Erbium laser, such as Fraxel Repair or Active/Deep FX
- Fully ablative laser, like the UltraPulse CO2 laser, which Dr. Butterwick describes as the gold standard as it produces more thermal damage for better tissue constriction and collagen production
- Combination laser treatment to address multiple concerns and produce a superior outcome
The ablative laser produces the most dramatic, long-lasting results, but also requires the most downtime out of all the treatment options. Dr. Butterwick explains that the day after treatment, the skin will be significantly crusty and oozing, but those side effects will improve over the following days. By day seven, many patients will venture out, covering the treatment area with a mask. Dr. Butterwick points out that this is the perfect time to undergo an ablative laser treatment, since regular mask wearing makes it easy to keep the evidence of the procedure under wraps. This laser produces our Take10 results, taking 10 years off your appearance and repairing years of sun damage.
Fillers for Wrinkles and Laxity
When patients do not have time for recovery after a laser treatment, injectable fillers can also produce some improvement in etched-in lines around the mouth. Fillers offer the benefit of immediate results, while laser improvements tend to develop in the weeks following the procedure. There is also no downtime after injectable treatments, although patients might have some mild bruising around the injection sites. The biggest drawback to injectables is that the improvements are temporary and patients will need to repeat the procedure every 6-9 months to maintain their positive results.
Dr. Butterwick recommends the following fillers for superficial lines:
- Belotero
- Volbella
- Restylane Silk
- RHA 2
The smooth consistency of these products ensures they can produce a natural result for perioral lines, smile lines, and chin wrinkles. These fillers are lightweight and won’t cause unnatural fullness.
Skin laxity can lead to deeper wrinkles, which you can also address with injectable fillers in some cases. By adding volume to the cheeks and perimeter of the face, Dr. Butterwick can lift these tissues, thereby reducing lines and wrinkles around the mouth, including those stubborn nasolabial folds. Some fillers like Vollure and Restylane Refyne are great for direct placement in the folds. The best fillers for lifting include:
- Restylane Lyft
- Restylane Refyne or Defyne
- Juvéderm Voluma
- RHA 4
- Vollure
- Radiesse
- Sculptra
For sagging in the lower face, Dr. Butterwick also uses special injection techniques, which she has named the “picket fence” and “secret lift.” These techniques hide the injection spots along the perimeter or in the hairline and truly give a lift around the mouth. Autologous fat transfer is another choice for treating deep creases and loss of definition along the jawline, with potentially more durable results than fillers. With many tricks up her sleeve, it is clear that patients who work with an experienced, board-certified dermatologist like Dr. Butterwick are sure to get the most personalized treatments and the best possible results.
What is Skin Boosting?
When multiple fine lines are present in a single area, Dr. Butterwick often uses a technique she calls skin boosting. This process involves administering small amounts of dilute filler into the superficial skin layers to smooth the surface of the skin. By using a micro-cannula instead of a needle, Dr. Butterwick can effectively fan the filler throughout all the lines. She then follows up with needle injections of filler to the remaining lines, creating a smooth, hydrated, refreshed appearance.
How to Achieve Deep Tissue Tightening
When sagging becomes more evident, fillers are unlikely to be a sufficient treatment option. We can’t try to fix everything with fillers, or you will get an overfilled, unnatural look. At this point, Dr. Butterwick often turns to skin tightening devices that use a variety of energy sources to affect the tissue deep beneath the surface. Some of her favorite devices include:
- Micro-focused Ultrasound – Ultherapy
- Monopolar Radiofrequency (RF) – Thermage
- RF Microneedling – Intracel
- Percutaneous RF – ThermiTight
All of these devices work on the same basic principle. Energy emitted from the devices is delivered into the deep tissue, where it constricts tissue and stimulates the body to produce more collagen. The heating is precise to ensure the desired result without damaging skin or surrounding tissue. Ultherapy and Thermage are performed on the surface of the skin, while ThermiTight uses monopolar RF probes under the skin to work even deeper into the subcutaneous layer. RF microneedling creates micro-channels on the skin’s surface, allowing RF energy to be delivered deep into the channels for a more dramatic effect.
Ultherapy, Thermage, and ThermiTight all produce full results after a single treatment session, while RF microneedling requires a series of treatment sessions to achieve the best outcome. None of the procedures require any downtime afterward. Tightening also improves skin elasticity and is a great way to stay youthful. Dr. Butterwick recommends tightening every one to three years, depending on age and the condition of the skin.
Lift and Smooth with these Procedures
When skin and tissue fall downward and fat collects in the jowls and under the skin, volume redistribution or removal is necessary. There are effective procedures for addressing early jowl formation and adding youthful definition along the jawline.
Removing Fat from the Jawline
Jowl formation is caused by a variety of factors, including loss of jawbone, loose skin, and the movement of fat to the lower area of the face. Dr. Butterwick uses injections of Kybella for small amounts of fat accumulation along the jawline with excellent results. Patients may need 2-3 treatments to achieve the best possible effect. Micro-Liposuction is another simple procedure for reducing jowls in just one treatment.
Thread Lifts for Noticeable Results
To achieve noticeable lift in the mid and lower face, Dr. Butterwick often recommends the Silhouette InstaLift. This thread lift places dissolvable threads just under the dermal tissue, where they lift and tighten the tissue to restore a more youthful facial contour. Dr. Butterwick prefers the Silhouette threads to PDO threads because they produce the most lifting with improvements that can last 18 to 24 months—even longer if patients combine the thread lift with other procedures such as fillers.
Dr. Butterwick is a trainer and educator for the SIlhouette Instalift, and she and the other board-certified dermatologists at Cosmetic Laser Dermatology in San Diego perform the Silhouette InstaLift using topical numbing. There is no downtime after the procedure, although patients may experience some minor bruising and swelling for a few days. Like all treatments offered at our medical spa, our dermatologists can customize this procedure to the precise needs of each patient for the most natural results.
Making the Most of Your Treatments At Our Medical Spa
No matter which treatment works best to address wrinkles and sagging around the mouth, Dr. Butterwick stressed that patients see the best outcomes when they combine professional treatments with daily use of cosmeceuticals at home. She broke down the results like this:
- 70% of improvement comes from the procedure
- 30% of improvement is achieved with cosmeceuticals
- 100% improvement is possible when patients use both
Cosmetic Laser Dermatology offers a full online skin care store, with professional guidance in our office to help patients select the best formulations for their specific skin type. As a start to any skin care system, Dr. Butterwick recommends daily use of sunscreen, morning application of an antioxidant, and night time application of retinoids and growth factors.
Schedule A Consultation in San Diego, CA Today
It appears that we will continue to wear masks into the foreseeable future, so why not take advantage of this time to rejuvenate your lower face? With a mask to hide your healing, you will be able to venture out sooner. And when the pandemic is finally over, you will have a refreshed appearance to flaunt to the world. To learn more about the best procedures for you, contact Cosmetic Laser Dermatology at (858) 943-2113 to schedule your consultation at our San Diego medical spa today.
