Perioral Rejuvenation: Treating the Mouth Area

Last updated: 5 March 2026

Why the perioral area ages rapidly

The perioral region, the area around the mouth including the lips, upper and lower lip borders, marionette lines, and chin, is one of the most dynamic and expressive zones of the face. It is subject to constant movement from speaking, eating, and expressing emotion, making it particularly susceptible to the signs of ageing. Perioral ageing affects self-confidence significantly, as the mouth is central to facial communication and attractiveness.

Clinics offer comprehensive perioral rejuvenation using a combination of techniques that address volume loss, skin quality, dynamic lines, and structural support.

Anatomy of perioral ageing

Multiple structural changes contribute to perioral ageing:

• Lip volume lossthe lips thin progressively from the mid-twenties onwards, losing both volume and definition of the vermilion border
• Perioral lines (smokers lines/barcode lines)vertical lines radiating from the lip border, caused by orbicularis oris muscle contraction and skin thinning
• Nasolabial foldsdeepening grooves from the nose to the mouth corners, resulting from midface descent and fat pad atrophy
• Marionette lineslines running from the mouth corners to the jawline, creating a sad or disapproving expression
• Oral commissure downturnthe corners of the mouth turn downward with loss of structural support
• Chin changeschin recession and cobblestone or peau dorange chin texture from mentalis muscle hyperactivity
• Maxillary resorptionbone loss in the upper jaw contributes to loss of lip support and deepening of the nasolabial fold
• Philtrum flatteningthe two ridges running from the nose to the upper lip become less defined

Treatment Approaches

Lip enhancement and rejuvenation

Age-appropriate lip treatment focuses on restoration rather than augmentation:

• Border definitionsubtle filler along the vermilion border to restore lip definition and reduce lipstick bleed
• Volume restorationreplacing lost volume to restore a natural, age-appropriate fullness
• Philtrum enhancementdefining the philtral columns to restore the Cupids bow architecture
• Product choicesoft, flexible HA fillers designed for lips (Juvederm Volbella, Restylane Kysse, Teosyal Kiss)
• Techniqueconservative approach using small amounts to maintain natural proportions and movement

Perioral lines treatment

Vertical lip lines require a multi-modal approach:

• Botulinum toxinvery low doses to the orbicularis oris reduce the dynamic component. Must be applied conservatively to avoid affecting lip function (speech, drinking through a straw)
• Superficial fillerfine threads of soft HA filler placed directly into persistent lines
• Skin resurfacingfractional laser, chemical peels, or microneedling to stimulate collagen and smooth skin texture
• Skin boostersimproving perioral skin quality and hydration

Nasolabial fold management

• Midface volumisationaddressing the cause (midface descent) by restoring cheek volume, which lifts the fold from above
• Direct fold fillingmedium-viscosity HA filler placed beneath the fold (after midface support is established)
• Combined approachbest results come from addressing both the cause (cheek support) and the effect (fold depth)

Marionette lines and oral commissures

• Filler supportplaced at the oral commissure and along the marionette line to lift and support
• Botulinum toxinto the depressor anguli oris (DAO) muscle to reduce downward pull on the mouth corners
• Jaw and chin supportstructural filler to the chin and pre-jowl sulcus provides foundation support

Chin Rejuvenation

• Mentalis treatmentbotulinum toxin to the mentalis muscle reduces the dimpled or orange peel chin texture
• Chin projectionfiller to enhance chin projection and length, improving lower face proportions
• Pre-jowl fillingaddressing the depression that forms between chin and emerging jowl

Comprehensive perioral rejuvenation plan

A staged approach delivers the most natural-looking results:

1. Session 1: Midface volumisation (cheek support) and chin/jaw structural filler
2. Session 2 (4-6 weeks later): Assess improvement in nasolabial folds and marionette lines. Address residual concerns with direct filler, lip restoration, and botulinum toxin to DAO and mentalis
3. Session 3 (4-6 weeks later): Perioral skin quality, laser resurfacing, chemical peels, or microneedling for perioral lines and skin texture
4. Maintenance: Top-up treatments every 6-12 months, ongoing skincare including retinoids and SPF

Special Considerations

• Dental assessmenttooth loss or dental malocclusion significantly affects perioral aesthetics. Address dental concerns before or alongside aesthetic treatments
• Smokingactive smoking accelerates perioral ageing and reduces treatment longevity. Cessation advice should be part of the consultation
• Vascular anatomythe superior and inferior labial arteries run near the lip border. Practitioners must have thorough knowledge of the vascular anatomy to avoid vascular compromise
• Proportionsthe ideal upper-to-lower lip ratio is approximately 1:1.6. Treatment should respect individual facial proportions and ethnic features

“Perioral rejuvenation is one of the most impactful areas of facial aesthetics. Restoring the mouth area restores the ability to smile confidently, and that emotional benefit goes far beyond the physical improvement.”, Journal of Cosmetic Dermatology

Frequently asked questions

Summary

Perioral rejuvenation requires a comprehensive, multi-treatment approach that addresses structural support, volume loss, dynamic lines, and skin quality. By treating the mouth area as a complete aesthetic unit rather than focusing on individual lines or features, natural-looking results that enhance facial harmony and expression can be achieved. Practitioners understand the nuances of perioral anatomy and ageing, delivering personalised treatment plans that restore confidence and natural features.