Background
The aging process can cause midface retrusion, elongation of the upper lip, and a loss of youthful features that are, with age, increasingly difficult to restore in a natural- appearing contour. Bone loss is a well- known contributor to this phenomenon, but the role of muscle atrophy has been largely overlooked.
While youthful upper lips have a strong, thick muscle layer that supports the overlying skin, aging lips become measurably longer in part due to lack of muscle support and adhesion. Combining transcutaneous radiofrequency (RF) muscle stimulation with the injection of microfat and nanofat can generate a significantly improved upper lip appearance with measurable increase of orbicularis muscle thickness, lip eversion and shortening of the philtral column bilaterally. Resurfacing is used in cases of strong vertical rhytides.
Materials and methods
Ten female patients over the age of 50 with clinical complaints of upper lip elongation, thinning, lack of a defined philtral column and Cupid’s bow, as well as inversion of the upper lip vermilion, were treated using a combination of transcutaneous intra- muscular RF energy followed by nanofat- enriched fat grafting.
The microinsulated RF needles were used to stimulate the orbicularis muscle from the base of the nose to the vermilion border. A 5 mm F1a needle was used at a power level of 7 to stimulate the muscle for 400 ms per pulse in a grid about 4 mm apart. Just above the edge of the lip vermilion, the device was used in a tight linear manner to create upper lip eversion.
Philtral columns were enhanced using a W3b microinsulated needle at a 3 mm depth intradermally. Nanofat-enriched microfat was injected intramuscularly in 0.2 cc aliquots. A similar mixture was injected along the vermilion border and intramuscularly at the wet/dry mucosa. In cases of severe vertical rhytides, erbium laser resurfacing was also performed.
Results
All patients saw a significant improvement in lip contour. Thickening of the upper lip was measured using ultrasound. Though the current sample size is small, an average muscle thickness increase was noted at 2.3 mm two months post-treatment. Defined lip eversion and philtral column definition peaked at one week, then lost slight correction over time.
Measurable upper lip shortening averaged 3.3 mm as seen with Vectra measurements along the philtral columns at two months post-treatment. Notable contour improvement was also achieved. A limitation of this series is a lack of long-term data. Patients will be reassessed at six months and one year. No skin excision was performed.
Conclusion
Targeted treatment of the orbicularis muscle with nanofat and myostimulation can shorten the elongated upper lip and can measurably thicken the orbicularis muscle. Reversal of visual perioral markers of aging, as well as a significant upper lip lift without surgical excision, can be achieved using this combination treatment technique.
About the author
Diane Duncan, MD, FACS
Dr. Duncan is an internationally known innovator and educator. Current projects include clinical research and product development
in a variety of areas including electromagnetic myostimulation, regenerative medicine, tissue engineering, energy-based devices, and minimally invasive solutions for patients seeking minimal downtime. Dr. Duncan is a member of the editorial board of the Aesthetic Surgery Journal, and is a speaker at leading industry conferences around the world.
