Rejuvenation of the aging mouth.

Viewing the face as a series of three concentric rings, we can successfully rejuvenate the outer ring with the usual face lift, blepharoplasty, and brow lift. Insufficient attention has been paid to the middle and inner rings. The middle ring can be made to look more youthful by correcting the long upper lip with a lip lift, elevating the downturned corners with corner lifts, excising the deep nasolabial furrows, placing a chin implant to correct both the lateral chin-jowl indentations (the fleur-de-lis look) and the drooping chin, and dermabrading the wrinkles. The inner ring can be youthened by creating fuller lips either by the surgical augmentation techniques of inner flaps or vermilion advancements or by injection enhancement with a filler material. Our experience with 1300 procedures indicates that the successful rejuvenation of the middle and inner rings adds a great deal to appearance and satisfaction, the patient often appearing 10 to 15 years younger. Unknowingly altering a locus of identity in the mouth area can lead to significant patient upset and should be avoided. Guiding principles for cosmetic surgery around the mouth have been suggested.