How can I get rid of the parentheses around my mouth?
You actually have several options:
- Fillers. The most common treatment for marionette lines and mouth area wrinkles is fillers such as Juvederm. I prefer using hyaluronic acid-based fillers as opposed to anything else on the market as they lend a smooth natural appearance. Depending on the depth of the lines, one or two vials of filler may suffice. One advantage of this treatment is that it provides instant gratification, although the effects may not last much longer than a year.
- Dermal-fat grafts. I use these when I’m performing facelifts or any procedure that offers the opportunity to harvest the patient’s own dermis and fat. In such cases, I’ll prepare two small grafts that can be inserted under the skin to permanently efface the lines. This provides a permanent solution with natural results.
- Facelift. The facelift procedure by itself eliminates or significantly improves the lines by lifting the soft tissues of the cheek.
- Cheek implants. I typically use cheek implants made of silicone. They naturally contour the cheek bones while compensating for the loss of soft tissue and bone that occurs over time. Along with the desired contouring effect they significantly improve the parenthesis lines around the mouth.
- Fat injections. This option offers a permanent filling effect to the lines. That said, it’s important to note that because 40-60% of the fat is reabsorbed, it’s imperative that the fat be over-injected at first in order to reach the desired volume over the course of a two to three-month period. This, however, is not my preferred approach to the problem because fat as a filler is predictably unpredictable.
These solutions all need to be thoroughly discussed with the patient. Ultimately, an option is chosen based on the patient’s expectation and depending on the context and the site of treatment – in the office or in the operating room.
Dr. Vartan Mardirossian, Mardirossian Facial Aesthetics, Jupiter, FL
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