The Ageing Lip – Anatomy & Process

Lips are one of the most expressive features of the human face. They communicate youth, vitality, sensuality, and character. However, like every other facial structure, the lips are not immune to the passage of time.

Understanding how the lips age, and how to treat them effectively and ethically, is essential for medical aesthetic practitioners aiming to deliver natural, harmonious results.

Why Do Lips Age?

The process of lip ageing is complex and multifactorial. It’s not just the soft tissue of the lip that changes; bone structure, muscle function, and skin quality all play vital roles. Over time, the upper lip tends to elongate and lose volume. The Cupid’s bow may flatten, the vermillion border can become less distinct, and vertical lines (often called “smoker’s lines”) begin to appear around the mouth. Even in non-smokers, these lines develop due to repetitive muscle movement and the natural thinning of the dermis.

Internally, several anatomical changes are happening. Bone resorption in the maxilla reduces structural support for the upper lip, causing it to retract and lose projection. The fat pads that provide volume gradually diminish, contributing to a thinner, less defined appearance. Meanwhile, the orbicularis oris muscle, responsible for lip movement, becomes more active as it compensates for these changes, further deepening dynamic lines. Tooth loss or dental ageing may also play a role by altering how the lips are supported from within.

These physiological changes are compounded by environmental and lifestyle factors such as sun exposure, smoking, and repetitive facial expressions, which accelerate collagen and elastin breakdown. As a result, patients often report that their lips feel “deflated” or that lipstick now bleeds into fine lines – subtle cues that indicate the onset of perioral ageing.

Recognising the Signs

Clinically, an ageing lip presents in several ways.

• The vermillion may appear less prominent.
• The upper lip can begin to curl inward or flatten.
• The definition of the Cupid’s bow may be lost.
• Philtral columns may appear diminished or less vertical.
• The oral commissures often start to turn downward, creating a tired or sad expression.
• In advanced ageing, the red-to-white lip ratio shifts significantly, and the overall appearance becomes less vibrant and structured.

Aesthetic Approaches to Lip Ageing

Treating the ageing lip requires more than simply injecting volume. A thoughtful, layered approach is crucial, one that considers anatomy, movement, proportions, and skin quality.

Dermal fillers remain one of the most effective tools for restoring volume and reshaping the lip. When used correctly, they can reinstate the soft, plump appearance associated with youth while respecting natural movement and proportions. A soft, hyaluronic acid-based filler is generally preferred for lip treatments, especially in older patients where the tissue is more delicate. Rather than aiming for dramatic augmentation, the goal is typically to restore structure, define the vermillion border, and support the philtral columns.

In some cases, botulinum toxin can be used to complement filler treatments. When injected in very small amounts around the orbicularis oris, it can help soften perioral lines caused by muscular overactivity. The popular “lip flip” technique, where a small dose of toxin is placed into the upper lip to help evert it slightly, can also enhance lip show without the need for additional volume – particularly helpful in patients who are wary of looking “overdone.”

Beyond fillers and toxin, biostimulatory treatments are becoming increasingly popular in managing the signs of ageing. Polynucleotides, for instance, have shown promise in improving dermal quality and encouraging collagen synthesis. When used as part of a wider treatment plan, these regenerative options can significantly enhance the perioral region’s texture and resilience.

Skin boosters or microneedling may also be employed to address superficial concerns, such as fine lines and textural irregularities. And in some patients, energy-based treatments like fractional lasers or light peels can help resurface the skin and reduce deeper rhytids.

Considerations and Cautionary Notes

One of the most common mistakes when treating ageing lips is overfilling. In an attempt to restore lost volume, it’s easy to add too much product, which can result in an unnatural or disproportionate look. A subtle, progressive approach is nearly always more appropriate, especially for older patients. It is also essential to observe the lips in motion, not just at rest. Static assessment doesn’t reveal how the lips behave when talking, smiling, or pursing -which is often when the signs of ageing become most noticeable.

Equally important is considering the lower face as a whole. Lips do not age in isolation, and treating them in context with the chin, marionette lines, and jawline ensures a more balanced and harmonious result. Dental health should not be overlooked either. Changes in dentition and bite can significantly impact lip projection and overall perioral aesthetics.

Final Thoughts

The ageing lip is a reflection of deeper anatomical and physiological changes that occur over time. As aesthetic clinicians, our responsibility is to understand this complexity and treat it with a subtle, sophisticated approach. By combining technical precision with artistic judgment, and by respecting the natural proportions and movement of the lips, we can help our patients age gracefully, confidently, and beautifully.

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