Can Perioral Folds Be Cut Out?

Q: Dr. Eppley, Would this mess on the side of my mouth be correctable without a facelift? Just an incision beside mouth? I had filler placed there over a year ago and ever since it looks terrible. I have also had the area melted with devices and I am left like this. I’d take a scar any day over this mess. Thank you.

A: Thank you for your inquiry and sending your picture. With the development of perioral folds I would expect any treatment that involved adding volume (fillers) or skin tightening/fat reduction efforts to merely exaggerate the problem. This is a surgical issue that requires either direct or indirect tissue excision/rearrangement. Even though it is an indirect approach, there is no doubt that a lower facelift is the superior approach to trying to smooth out this area by distant tissue excision and skin pull and is also scar free by the mouth area. However there is a direct approach which is an elliptical tissue excision placed above the perioral folds along the line of the nasolabial fold. (see attached image) It typically is reserved for much older patients who have a very deep nasolabial fold anyway which is the equivalent of a pre-existing scar. Bit it can be done on anyone if they are motivated enough to want to avoid a facelift and can accept the scars.

Dr. Barry Eppley

Indianapolis, Indiana