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Facial Plast Surg 2021 Apr 12;37(2):176-193. Epub 2021 Apr 12.

Medicina Estética, CM Clinic, Palma de Mallorca, Islas Baleares, Spain.

Perioral region, although severely impacted by facial aging, is often overlooked in texts on facial rejuvenation. Sun exposure, bone resorption, dynamic contraction of the sphincteric and nonsphincteric oral musculature, gravitational pull, histological changes of the skin, and unhealthy habits all take their toll in this area. Fine wrinkling on the lips, deep nasolabial and mentolabial folds, elongation and flattening of the upper lip, downturned corners of the mouth, marionette lines, diminished vermillion and upper teeth show and chin irregularities are the main signs of this process, raising great concern amongst patients and making the perioral region the most demanded area for facial rejuvenation treatment. Read More

Facial Plast Surg 2021 Feb 22. Epub 2021 Feb 22.

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan.

Successful management of lip and perioral trauma requires a nuanced understanding of anatomy and surgical techniques. Surgical correction is particularly challenging in instances of tissue loss, due to a narrow tolerance for aesthetic deformity and highly specialized functions of the perioral region, including facial expression, communication, and oral competence. Restoring continuity of the orbicularis oris musculature is critical for dynamic sphincter function of the upper and lower lips. Read More

Surg Endosc 2020 03 30;34(3):1088-1102. Epub 2019 May 30.

Division of Endocrine and Minimally Invasive Surgery, "G. Martino" University Hospital, Messina University, Sicily, Italy.

Background: The number of TOETVA surgeries has increased worldwide but the anatomical passage of trocars is not clearly defined. We aimed to define detailed surgical anatomical passage of the trocars in cadavers. The incisions in oral vestibule, anatomical pathways of trocars, affected mimetic muscles, neurovascular relations of trocars and histological correlation of surgical anatomy were investigated. Read More

Facial Plast Surg 2019 Apr 3;35(2):172-175. Epub 2019 Apr 3.

Department of Facial Plastic Surgery, Chicago Center for Facial Plastic Surgery, Chicago, Illinois.

As individuals age, distinct anatomical changes of the bone and soft tissue result in the development of rhytids in the perioral region. Most notably, the oral commissures turn downward, creating the appearance of a perpetual frown and adding years to the facial appearance. The purpose of this article is to review the anatomical changes associated with perioral aging as well as discuss potential treatment options for perioral rejuvenation particularly at the level of the oral commissures. Read More

Facial Plast Surg 2019 Apr 3;35(2):134-139. Epub 2019 Apr 3.

Greene MD Plastic Surgery and Laser Center, Weston, Florida.

Enhancement of the lips with facial fillers is currently one of the most popular nonsurgical cosmetic treatments worldwide. Patients from all age ranges have interest in these treatments, but there is wide variance of their esthetic goals. Practitioners must be aware of the challenges posed by both the youthful and mature lip, which usually requires different approaches and techniques. Read More

J Eur Acad Dermatol Venereol 2019 Feb 6;33(2):305-311. Epub 2018 Nov 6.

Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.

Background: The lip and surrounding perioral region are susceptible to non-melanoma skin cancer, but the distribution of basal cell and squamous cell carcinoma on the cutaneous and vermilion lips has not been fully elucidated.

Objective: To investigate the distribution of cutaneous and vermilion lip non-melanoma skin cancer and to better describe risk factors, anatomic location, treatment characteristics and oncologic outcomes.

Methods: A retrospective comparative case series of patients undergoing Mohs micrographic surgery (MMS) at a single academic centre for lip and perioral basal cell and squamous cell carcinoma was performed over a 5-year period. Read More

Rejuvenation Res 2018 Dec 8;21(6):553-559. Epub 2018 Aug 8.

3 Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.

The ideal perioral and lip rejuvenation technique provides the longest period of efficacy, lowest complication rate, and best esthetic results. Genetics, intrinsic aging, sun exposure, and repetitive muscle twitching of the orbicularis oris produce angular, radial, and vertical lines of the perioral lines and, for this reason, the needs of patients in the treatment of this anatomical area can range from simple lip enhancement to a broader and more comprehensive treatment with simultaneous correction of perioral wrinkles. A myriad of materials have been described for rejuvenation of this area. Read More

Oral Surg Oral Med Oral Pathol Oral Radiol 2018 Feb 30;125(2):e22-e30. Epub 2017 Aug 30.

Department of Oral Pathology and Medicine, School of Dentistry, National and Kapodistrian University of Athens, Greece.

Squamous cell carcinoma (SCC) developing in lesions of discoid lupus erythematosus (DLE) is rare, most frequently arising on sun-exposed skin and very rarely affecting the lips. A review of the English language literature revealed only 21 published cases of labial SCC in patients with DLE. Here, an unusual case of a patient with DLE who developed 3 primary SCCs of the oral and perioral region is presented. Read More

J Cosmet Dermatol 2018 Aug 17;17(4):578-583. Epub 2017 Jul 17.

Faculdade de Odontologia, Departamento de Clínica, Patologia e Cirurgia Odontológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

The use of cosmetic fillers agents in orofacial region has become more often used for esthetic concern. Although adverse effects are rare, some patients may develop foreign body reaction to such fillers. Hyaluronic acid (HA) is a biomaterial in the spotlight, because it is normally present in several tissues of human body. Read More

Ned Tijdschr Tandheelkd 2017 Jun;124(6):325-332

The perioral region is unique and important in the face, both from a functional and an aesthetic point of view. There is a strong relationship between the perioral soft tissues, such as the lips and the corners of the mouth, and the underlying dentition and the jaws. Perioral ageing phenomena, such as depressed corners of the mouth, volume loss and wrinkles, can be improved, however, to a limited extent with intraoral treatment. Read More

Braz Dent J 2016 Sep-Oct;27(5):625-628

Department of Oral Diagnosis (Semiology and Pathology) - Piracicaba Dental School - UNICAMP - Universidade de Campinas, Piracicaba, SP, Brazil.

Furuncular myiasis is a parasitic infection caused by the larvae of Dipteran insects after penetrating healthy skin, causing an erythematous nodule with a central pore. Additionally, the patient may feel a sensation of movement and intermittent pain. Furuncular myiasis affecting the oral and perioral region is rare, usually leading to misdiagnosis. Read More

Facial Plast Surg Clin North Am 2017 Feb;25(1):55-71

Facial Plastic and Reconstructive Surgery, Penn State Hershey Medical Center, 500 University Drive H091, Hershey, PA 17033, USA; Fedok Plastic Surgery, 113 East Fern Avenue, Foley, AL 36535, USA; Department of Surgery, USA Medical Center, The University of South Alabama, 2451 Fillingim Street, Mobile, AL 36617, USA. Electronic address:

Lip and chin scarring occurs owing to reconstruction of congenital, cancer resection, or traumatic defects. Knowledge of lip anatomy and function is critical to optimize results. Realistic expectations should be established before intervention. Read More

Ann Plast Surg 2017 Mar;78(3):334-337

From the Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany.

Background: Although aging changes of the female perioral region and aesthetic procedures for perioral rejuvenation are described in literature, specific data for the male population are lacking. This study aims to evaluate perioral aging process in the male population to compare quality and quantity of the observed changes to the female population.

Methods: Magnetic resonance imaging (MRI) scans of 22 male subjects, were recruited into 2 age groups: young (20-35 years) and old (65-80 years) and the following parameters were measured: length of visible upper lip, thickness of upper lip at the level of vermilion border, thickness of upper lip at the level of the mid lip, and cross-section area of upper lip. Read More

J Craniomaxillofac Surg 2016 Jul 13;44(7):835-42. Epub 2016 Apr 13.

Department of Gynecology and Obstetrics, Delafontaine General Hospital, 2 rue du Docteur Pierre-Delafontaine, 93200 Saint-Denis, Seine-Saint-Denis, France. Electronic address:

The ultrasonographic surface rendered oro-palatal (SROP) view is a 3D reconstructed view of the fetal perioral region, which combines ultrasound insonation in a trans oral, upward directed axial direction and the surface rendered mode. It allows the simultaneous visualization on a single scan of the superior lip, alveolar ridge and secondary palate. It corresponds prenatally to the submental intra oral photography of the palate of neonates. Read More

Plast Surg Nurs 2016 Jan-Mar;36(1):12-8; quiz E1

Tracey A. Hotta, RN, BScN, CPSN, CANS, is the owner and president of TH Medical Aesthetics. She is the past president of ASPSN, Editor of the Plastic Surgical Nursing journal, and is a Managing Partner of ACE+ Academia a div of HsuHotta Inc.

Rejuvenation of the perioral region can be very challenging because of the many factors that affect the appearance of this area, such as repeated muscle movement causing radial lip lines, loss of the maxillary and mandibular bony support, and decrease and descent of the adipose tissue causing the formation of "jowls." Environmental issues must also be addressed, such as smoking, sun damage, and poor dental health. When assessing a client for perioral rejuvenation, it is critical that the provider understands the perioral anatomy so that high-risk areas may be identified and precautions are taken to prevent serious adverse events from occurring. Read More

Zootaxa 2015 Nov 10;4040(1):74-82. Epub 2015 Nov 10.

Department of Plant Pathology, Faculty of Agriculture, Tarbiat Modares University, Tehran, Iran; Email:

Tylencholaimellus persicus sp. n. is described and illustrated based on morphological and molecular characters. Read More

J Plast Reconstr Aesthet Surg 2015 Jul 21;68(7):920-9. Epub 2015 Mar 21.

Department of Plastic and Hand Surgery, University Medical Center Freiburg, Freiburg, Germany.

Background: Throughout literature, there are different parameters defining the ideal shape of the lip and lower third of the face. This study was conducted to clarify what it is that makes lips attractive - and whether there are gender-related differences of an attractive lip and lower third of the face.

Patients And Methods: Pictures of the lip and chin region of 176 patients were photographed in a standardised way and evaluated by 250 voluntary judges through an internet presentation by means of an analogue Likert scaling system. Read More

Aesthet Surg J 2015 Jul 24;35(5):504-15. Epub 2015 Apr 24.

Drs Bernardini and Zambelli are oculofacial plastic surgeons in private practice in Genova, Milano, and Torino, Italy. Drs Gennai and Izzo are plastic surgeons in private practice in Bologna, Italy. Dr Repaci and Prof Dr Quarto are Researchers in the Department of Experimental Medicine, University of Genova, Italy. Dr Baldelli and Prof Dr Santi are Plastic Surgeons in the Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Italy. Dr Fraternali-Orcioni is a Pathologist in the Department of Pathology, University of Genova, Italy. Dr Hartstein is an Oculofacial Plastic Surgeon at Assaf Harofhe Medical Center in Zerifin, Israel.

Background: Although recent research on micro fat has shown the potential advantages of superficial implantation and high stem cell content, clinical applications thus far have been limited.

Objectives: The authors report their experience with superficial enhanced fluid fat injection (SEFFI) for the correction of volume loss and skin aging of the face in general and in the periocular region.

Methods: The finer SEFFI preparation (0. Read More

J Craniofac Surg 2015 Mar;26(2):506-8

From the Peking Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.

Various types of anterior chest flaps can be recruited in the reconstruction of faciocervical region. Most of them were created based on the internal mammary artery and the lateral thoracic artery, and the thoracoacromial artery (TAA) is usually used in pectoralis major musculocutaneous flap. An anterior chest flap with TAA perforator (TAAP) will have no sacrifice of the pectoralis major muscle, but less reports, especially expanded pedicled one, can be reviewed. Read More

BMC Res Notes 2014 Aug 7;7:495. Epub 2014 Aug 7.

Registrar in Medicine, Teaching Hospital, Kandy, Sri Lanka.

Background: Acquired angioedema is a rare but recognized manifestation of lymphoproliferative disorders due to deficiency in C1 esterase inhibitor. Normal level of C1 esterase inhibitor proteins in association with angioedema due to lymphoproliferative disease is a rare and an uncommon finding caused by antibodies produced from the underlying disease. Antibodies cause inactivation of C1 esterase inhibitor, thus resulting in C1 esterase inhibitor dysfunction despite of normal quantity of C1 esterase inhibitor. Read More

Zootaxa 2014 Jun 25;3821(5):538-50. Epub 2014 Jun 25.

Department of Zoology, Swedish Museum of Natural History, Box 50007, SE-104 05 Stockholm, Sweden; Email: unknown.

A new genus Neocamacolaimus gen. n., with one new species N. Read More

J Craniomaxillofac Surg 2014 Jul 1;42(5):e312-7. Epub 2013 Nov 1.

Department of Cranio-Maxillofacial Surgery & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747 Jena, Germany.

To adequately perform perioral rejuvenation procedures, it is necessary to understand the morphologic changes caused by facial aging. Anthropometric analyses of standardized frontal view and profile photographs could help to investigate such changes. Photographs of 346 male individuals were evaluated using 12 anthropometric indices. Read More

Clin Interv Aging 2013 2;8:1149-55. Epub 2013 Sep 2.

Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany.

Lips and the perioral area are of outstanding importance in youthful appearance, attractiveness, and beauty. In contrast to younger and middle aged females, there is only scant published data on minimally invasive procedures to restore and revitalize lips and perioral soft tissue in elderly females. In this review we report the signs of aging in this particular region and the underlying anatomy. Read More

Plast Reconstr Surg 2013 Sep;132(3):543-551

Plano and Dallas, Texas From the American Institute for Plastic Surgery and the University of Texas Southwestern Medical Center.

Background: Disharmonies of the upper lip aesthetic unit generally stem from tall ergotrids and/or thin lips. Comprehension and correction of such defects has been stifled by a lack of metrics and organized systems of diagnosis and treatment.

Methods: The philtral-labial score was devised to better analyze the upper lip region. Read More

Head Neck Pathol 2014 Mar 6;8(1):117-21. Epub 2013 Jun 6.

Division of Pathology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, 1-1 Keyakidai, Sakado, Saitama, 350-0283, Japan,

The hidrocystomas (HCs) are cystic forms of sweat gland resulting from proliferation of the apocrine secretory coil or eccrine duct. Apocrine -HCs are cystic lesions that arise from the apocrine secretory coil, while eccrine -HCs represent retention cysts of the eccrine duct. The commonest site for such lesions is around the eye, and they may also occur on the ears, scalp, chest, shoulders, or feet. Read More

J Cosmet Laser Ther 2013 Oct 21;15(5):279-85. Epub 2013 Jun 21.

Princess Grace Hospital, Ophthalmology and Oculoplasty , Monte Carlo , Monaco.

Purpose: To enhance lips ageing rejuvenation with specific microcannula and hyaluronic acid.

Method: Clinical review was conducted from December 2010 to December 2011 among 46 patients complaining of predictable changes on lips and perioral region such as deficiency in contour definition, volume and projection. Lips rejuvenation injections were made using the hyalurostructure technique. Read More

Front Oral Biol 2012 25;16:101-10. Epub 2012 Jun 25.

Department of Maxillofacial Surgery, King's College Hospital Foundation Trust, London, UK.

Surgical cleft repair aims to restore function of the oro-nasal sphincter and oro-nasal soft tissues and re-establish the complex relationship between perioral and perinasal muscle rings without compromising subsequent mid-facial growth and development. Here we review the surgical anatomy of this region, optimal timing for surgical repair and current thinking on the use of surgical adjuncts. In addition, an overview of current surgical techniques available for the repair of cleft lip, cleft palate and velopharyngeal insufficiency is presented. Read More

An Bras Dermatol 2012 May-Jun;87(3):456-8

Dermatology and Venereology Service, University of Coimbra Teaching Hospitals, Coimbra, Portugal.

Closure of perioral surgical defects involving the oral commissures is highly challenging. We describe a 69-year-old male patient with a large basal cell carcinoma of the right perioral region, extending to the right oral commissure. This lesion was radically excised, and the resulting surgical defect was closed using a homolateral double opposing rhomboidal flap. Read More

J Nutr Health Aging 2012 ;16(6):581-5

Department of Plastic and Hand Surgery, University Medical Center Freiburg, Freiburg, Germany.

Objectives: The perioral region is subject to a myriad of different treatments for rejuvenation, many of which are applied without a clear understanding of the underlying physiological processes of perioral aging. The results of these procedures are therefore sometimes not optimal and do not achieve a natural youthful appearance. The aim of this study was to put the results of three investigations into the perioral aging process into relation to clinical application in aesthetic medicine. Read More

Aesthet Surg J 2011 May;31(4):382-91

Departments of Plastic Surgery and Otolaryngology, University Hospitals-Case Western University, Cleveland, Ohio.

There has been minimal attention paid in the literature to the aesthetics of the perioral area, either in youth or in senescence. Aging around the lips traditionally was thought to result from a combination of thinning skin surrounding the area, ptosis, and loss of volume in the lips. The atrophy of senescence was treated by adding volume to the lips and filling the deep nasolabial creases. Read More