Dr. Little’s Philosophies
The dynamic feature of the mouth is of equivalent importance in overall facial aging as that of the eyes, with one or the other frequently predominating in the individual case. But while the eyes receive much attention during routine facial rejuvenation, the mouth typically receives little (or wrong) attention.
Aspects of the Aging Mouth
With aging, the mouth descends over the dental-skeletal framework, with the lengthening upper lip covering the upper teeth, while the sagging lower lip exposes the narrow lower teeth, especially during repose (relaxation) and speech. Also, the corners of the mouth typically slump downward, producing “bitterness folds” with their strongly negative connotations. Resuspension of mouth position therefore becomes important, although Dr. Little argues against external scars across the lip to accomplish this. Also, the lower lip typically losses volume, which can be naturally restored as an oval fullness to either side of a subtle central depression (rather than as a “tube”). While the upper lip loses little volume by contrast, it does flatten as it lengthens. Efforts to restore a forward pertness or kick at border of the lip are therefore appropriate, while overall enlargement may not be (thickened upper lips typically appear unnatural). Also, vertical skin lines or wrinkles that develop in some lips are also aging and need to be addressed.
Smile Must Be Protected
But all of this must be accomplished without altering the dynamics of the mouth or the individuality of the smile; specifically, there must be no distortion or “block” to the smile (as can increasingly be seen after an inartistic application of fillers or fat grafting). In addition to traditional still photographs, therefore, Dr. Little records pre- and post-operative video segments of all patients to examine such dynamic details. Multiple dynamic results are reviewed during the in-office consultation (some of which are included in the photographic Results / Face with Video subsection). Unnaturalness around the mouth or alteration of the smile is not an acceptable trade-off for a younger facial appearance.
Illustration: detail from Leonardo da Vinci, “Portrait of Lisa del Giocondo (Mona Lisa),” ca. 1503-1506, Musée du Louvre, Paris