Understanding Perioral Rejuvenation

Last updated: 9 August 2026

The perioral region, the area surrounding the mouth, is one of the first areas to show signs of ageing, yet it often receives less attention than the eyes or forehead in aesthetic treatment plans. Fine lines radiating from the lips, loss of lip volume, marionette lines, and nasolabial folds can collectively create an appearance of sadness or ageing that belies how patients actually feel. Practitioners take a comprehensive approach to perioral rejuvenation, addressing the entire lower face for natural, harmonious results.

Understanding perioral ageing

The perioral region ages through a combination of structural changes documented in research from the Plastic and Reconstructive Surgery journal:

• Bone resorptionthe maxilla and mandible lose volume with age, reducing the structural foundation that supports overlying soft tissue
• Fat redistributionperioral fat pads deflate and descend, which adds to nasolabial fold deepening and marionette line formation
• Muscle changesthe orbicularis oris muscle becomes hyperactive as it compensates for lost structural support, creating the repetitive contractions that form perioral lines
• Skin changescollagen and elastin degradation, combined with UV damage, leads to thinning, wrinkling, and loss of elasticity
• Lip changesloss of vermilion volume, vermilion border definition, and philtral column prominence
• Upper lip elongationthe distance from the nasal base to the lip border increases with age, concealing more of the teeth

These changes are compounded by environmental factors: chronic sun exposure on this often-neglected area, smoking (which dramatically accelerates perioral line formation), and habitual facial expressions.

Common perioral concerns

Perioral lines (smoker's lines)

Vertical lines radiating from the lip border are caused by the repeated pursing action of the orbicularis oris muscle, combined with age-related collagen loss. Despite the common name, non-smokers develop these lines as well, particularly those with thinner skin or greater perioral muscle activity.

Nasolabial Folds

The creases running from the nose to the corners of the mouth deepen with age due to midface volume loss and gravitational descent of the malar fat pad. Research in Aesthetic Surgery Journal (2020) classifies nasolabial folds on a five-point scale from mild to very severe.

Marionette Lines

The lines extending downward from the corners of the mouth create a puppet-like appearance and can convey an impression of permanent displeasure. These are caused by a combination of volume loss, jowl descent, and depressor anguli oris muscle activity.

Treatment Approaches

Botulinum Toxin

Carefully dosed botulinum toxin injections into the orbicularis oris can soften perioral lines by reducing the repetitive muscle contractions that deepen them. Precision is essential, over-treatment can impair lip function, affecting speech, drinking through a straw, and playing musical instruments. Practitioners use micro-doses (typically 2-4 units per injection point) to achieve subtle softening whilst preserving normal function.

For marionette lines, botulinum toxin into the depressor anguli oris (DAO) muscle can subtly elevate the oral commissures, softening the downturned appearance.

Dermal Fillers

Hyaluronic acid fillers address multiple perioral concerns:

• Nasolabial foldsmoderate-viscosity filler placed deep to the fold smooths the crease and supports the cheek-lip junction
• Marionette linesfiller placed along and lateral to the lines provides support and camouflage
• Lip volume and definitionrestoring lost lip volume and vermilion border definition
• Perioral linesvery soft filler placed superficially can fill individual lines, though this requires experienced technique to avoid irregularities

Skin Resurfacing

For the fine, crepey lines that characterise perioral ageing, skin resurfacing treatments can be highly effective:

• Chemical peelsmedium-depth peels (TCA 25-35%) improve skin texture and fine line depth
• Microneedlingpromotes collagen production with less downtime than ablative laser
• Radiofrequencytightens perioral skin through controlled thermal stimulation

The comprehensive approach

We advocate for treating the perioral region as part of the whole lower face. A treatment plan addressing only one concern in isolation often produces unbalanced results. A comprehensive approach might include:

1. Cheek volume restoration to address the root cause of nasolabial fold deepening
2. Lip rejuvenation for lost volume and definition
3. Botulinum toxin for dynamic perioral lines and DAO depression
4. Skin resurfacing for fine static lines
5. Chin and jawline support to address the structural foundation

Frequently asked questions

Can perioral lines be completely eliminated?
Significant improvement is achievable, but complete elimination of deep perioral lines is rarely possible without aggressive resurfacing. A careful approach focuses on meaningful improvement that looks natural rather than pursuing perfection that risks an overdone appearance.

Will treating nasolabial folds make me look unnatural?
When performed conservatively by an experienced practitioner, nasolabial fold treatment should look entirely natural. The goal is to soften the crease, not to eliminate it completely, a degree of nasolabial fold is normal and present even in young faces.

How long do results last?
Botulinum toxin in the perioral area typically lasts two to four months. Dermal filler in the nasolabial folds and marionettes lasts 9-15 months. Skin resurfacing results develop over three to six months and can last one to two years with proper skincare maintenance.

Is perioral treatment suitable for younger patients?
Many patients in their thirties begin to notice early perioral changes. Preventative treatment at this stage, such as retinoid skincare, sun protection, and early botulinum toxin, can significantly slow the progression of perioral ageing.