Perioral Lines: Is Botox Really Enough?
Perioral Lines: Honestly, I Used to Only Give Botox Too
As the weather gets drier these days,
I've noticed a significant increase in patients
pulling at the area around their mouth in front of the mirror in my examination room.
Many patients tell me that
"the area below the corners of my mouth sags
and makes me look angry."
Today, I'll explain the reason behind this
step by step.
They may look similar, but the key point is different
When we talk about perioral lines,
most people think of the fine horizontal lines
that appear directly below the lower lip.
More precisely, it's closer to
a 'structural shadow' that forms when the area
between the lower lip and chin tip becomes hollow.
Unlike crow's feet, which are expression lines caused by muscle contraction,
perioral lines are
'volume loss lines' caused by tissue deflation.
That's why Botox alone
produces less satisfying results than expected.
Why do some patients see less effect even with Botox?
Dr. Wi Young-jin's Key Insight
When the area below the lips becomes hollow, marionette lines deepen and you look much older than your actual age.
Supporting this area with a small amount of filler dramatically changes the impression around the mouth.
Today's Key Point
When the area below the lips becomes hollow
marionette lines deepen and
you look much older than your actual age.
Supporting this area with a small amount of filler
dramatically changes the impression around the mouth.
Last month, a patient in her early 40s came to see me,
expressing frustration that
"I've had filler injected into my marionette lines
twice at another clinic,
but my resting face still looks angry."
I immediately saw the problem.
It wasn't the marionette lines themselves,
but rather the area directly below the lower lip—
the perioral region—
that was significantly hollowed.
This hollowing caused the lower lip to
curl inward,
and that force pulled the mouth corners downward,
deepening the marionette lines
structurally.
Anatomically speaking,
this area is where the DLI (depressor labii inferioris) attaches,
and as we age, the fat pads thin out
and the bone also gradually recedes.
So for this patient,
instead of treating the marionette lines,
I injected just 0.3cc of hyaluronic acid filler
into the shallow dermal layer below the lips.
Specifically, 0.15cc on each side,
at a depth of 2-3mm in the subdermal layer
using linear injection technique.
When she returned two weeks later,
she was the first to say, "Doctor,
my husband asked me why I seem
so happy these days."
Even though I didn't touch
the marionette lines themselves,
they became noticeably shallower.
However, this approach isn't without drawbacks.
Since this area has significant mouth movement,
the filler typically lasts 6-9 months on average.
The duration is shorter than
cheekbones or jawline areas.
However, since we use only small amounts,
the cost burden for touch-up procedures isn't significant.
Dr. Wi Young-jin's Key Summary
Perioral lines aren't wrinkles—
they're 'hollowing.'
Don't just fill marionette lines;
first support the underlying perioral area
to change the entire impression around the mouth.
A small amount is sufficient.
Here's how I categorize them in my practice
While each case is different,
I usually classify them into one of three categories.
Sometimes there are combination cases too.
For combination cases, the sequence is important.
I typically address the hollowing first,
then add Botox or
skin procedures 2-3 weeks later.
If I do everything at once,
it's impossible to determine
which treatment produced the effect.
Three Most Common Questions in My Practice
Q1. Won't getting filler below the lips make my chin look more protruded?
A. This is a common misconception.
The perioral area is located above the chin tip.
Supporting this area actually
softens the boundary with the chin tip,
making the profile line appear smoother.
However, for patients whose chin tip already protrudes significantly,
I use even smaller amounts more carefully.
Q2. I'm curious about the cost and duration
A. Since we use only small amounts in the perioral area,
the cost burden isn't significant.
Duration averages 6-9 months;
for patients with significant mouth movement,
it may be slightly shorter.
I recommend coming back around 6 months
after the initial procedure to assess
whether touch-ups are needed—
this is the safest approach.
Q3. What about bruising or side effects?
A. This area has arterial branches
around the mouth passing through,
so special attention to blood vessels is crucial.
When an experienced doctor uses a cannula
for slow injection, there are usually no problems,
but bruising may last 2-3 days.
If you have important appointments,
I recommend scheduling
with about a week's buffer.
If you're unsure about concentration selection, please send a photo of your skin via KakaoTalk. This was Dr. Wi Young-jin.}
