Redermalization of the perioral zone

Lesya Linnik, plastic surgeon, member of the All-Ukrainian Association of Plastic, Reconstructive and Aesthetic Surgeons of Ukraine (VAPREX), doctor of the highest category, leading specialist of the Hyalual Institute (Ukraine, Kiev)

The condition of the lips and perioral area reflects the general state of health. Color, turgor, the presence of folds and wrinkles in the perioral zone and lips may indicate the pathology of certain organs and systems. The lack of subcutaneous fat leads to the rapid appearance of “purse-string” wrinkles and deformation of the lip contour; due to the loss of dermis volume, their “swelling” is lost. Since the skin of the lips does not have sebaceous glands, the lips begin to lack moisture faster than other parts of the face - they become dry, lose their appearance and shape. In addition, the skin of the lips does not contain pigments, and therefore lacks natural protection against UV radiation.

The aging process of the lips is determined by the peculiarities of the anatomy and physiology of this zone, as well as the increased sensitivity of the lips and perioral zone to the effects of external and internal factors.

Internal factors of aging begin to appear after 35 years and worsen with age. Hormonal aging (estrogen-dependent) leads to the formation of a fine network of wrinkles around the lips, worsening nasolabial folds, an increase in the number of visible hairs above the upper lip, thinning, flattening and pallor of the lips themselves.
External factors of aging include, first of all, photodamage to the skin under the influence of UVA and UVB rays. As a result of exposure to free radicals, damage to the cells of the epidermis and dermis occurs, and the hydrolipid mantle of the skin is destroyed. Clinically, it looks like dryness and flaking of the lips. Then pigmentation disorders appear, skin elasticity decreases, and there is a risk of developing tumors due to damage to the cell genome against the background of disruption of its normal metabolism.

Bad habits play an important role in provoking premature aging: smoking, poor diet, alcohol. They negatively affect the quality of the skin of the perioral zone, causing and accelerating the formation of free radicals, which leads to disruption of tissue trophism. Stress and insomnia lead to disruptions in the immune system of the entire body and skin, causing inflammation and the appearance of tumors. The habitat also becomes of great importance: weather factors (cold, heat, wind), air pollution, air conditioning, living in megacities - all this leads to dehydration and a decrease in the skin’s resistance to stress, and a slowdown in regeneration processes.

Thus, the problems of the perioral zone include:

• severity of nasolabial folds;
• the presence of oral commissures (“folds of bitterness” in the corners of the lips);
• the presence of “purse-string” wrinkles;
• drooping corners of the lips (“marionette lines”);
• violation of pigmentation in the perioral area;
• reduction in lip volume;
• deformation of the lip contour;
• peeling of lips and deterioration of their color.

Prevention or treatment?

In aesthetic medicine, methods for the prevention and treatment of aesthetic deficiencies associated with the aging process, rather than their disguise (invasive makeup), have begun to take first place.

The demand for anti-aging therapy is now growing and will continue to grow, since this method can slow down the rate of aging. In the first place should be methods that influence the pathophysiological mechanisms of aging. And only after restoration of normal metabolism in the skin are other types of correction (contour plastic surgery, botulinum therapy, etc.) permissible.

One of the procedures to prevent the aging process is redermalization using drugs containing sodium succinate (a salt of succinic acid) and unstabilized hyaluronic acid.

Among the main goals of redermalization are the following:

• reconstruction and strengthening of the dermis (by enhancing metabolic processes and restoring the underlying substance);
• stimulation of reparative processes;
• restoration of cellular metabolism;
• skin oxygenation;
• increasing the energy potential of cells;
• restoration of the hydrobalance of the dermis;
• activation of microcirculation (increased vasomotor activity of blood vessels, decreased blood stasis);
• creating an optimal physiological environment for skin cells.

Indications for the redermalization procedure in the perioral zone are:

• prevention of chrono- and photoaging;
• prevention of early skin aging caused by stress (smoking, taking medications, living in big cities);
• correction of age-related skin changes (wrinkles, dehydration, hypotension, skin atony);
• physiological preparation of the skin for contouring;
• preparing the skin for dermabrasion, deep and medium peels;
• rehabilitation after aggressive effects on the skin (chemical, physical, mechanical).

Visible signs of restoration and rejuvenation of the perioral zone will be improved skin turgor and tone, smoothing of skin microrelief, tone alignment, and “reinforcement” of increased facial stress. In addition, the skin's stress resistance to external adverse factors and its potential increases.

Correction of minor changes is carried out when there are initial signs of the formation of changes: shallow dermal cracks, the initial stages of drooping corners of the mouth and the formation of “marionette lines”, slight asymmetry. The procedure is performed using a papular or linear technique according to diagrams (Fig. 1–3).
The amount of the drug and the frequency of redermalization procedures are determined by the condition of the skin, the degree of damage by various factors, the severity of wrinkles, and the age of the patient.

Redermalization is also necessary for the physiological “immobilization” of the skin over the muscles, increasing the internal volume of tissue in places of the most pronounced atrophic processes, which leads to the smoothing of wrinkles.

Suitable combinations

Contour plastic surgery in the area of the lips and perioral zone is necessary to replenish lost volume and to straighten the contour, but tissue trophism is disrupted in the area of filler injection. Therefore, both before and after injection makeup, it is necessary to carry out redermalization in order to prolong the action of the filler and improve the condition of the skin. It is advisable to carry out 2-3 redermalization procedures both before and after contouring.

The perioral zone remains a “high-risk area” for botulinum therapy, however, the use of small doses of the toxin using the superficial injection technique is possible to relieve facial stress (vertical wrinkles above the upper lip, drooping corners of the mouth, a smile with exposed gums, wrinkles on the chin). The use of botulinum toxin can lead to disruption of the drainage function of muscles and skin (lymphostasis). Therefore, in order to improve tissue trophism, it is advisable to carry out redermalization two weeks before botulinum therapy and two months after it.
The combination of redermalization with hardware techniques (microcurrent therapy, laser correction, fractional photothermolysis, etc.) in solving problems of the perioral zone makes it possible to modulate the inflammatory reaction, stimulate the activity of skin cells, directing the repair process along a physiological path. Preparatory procedures (2 redermalization procedures with an interval of 1–2 weeks), as well as restorative procedures (2–3 sessions after hardware exposure) are advisable.

Nowadays, real anti-age therapy procedures, that is, therapy that affects the pathophysiological mechanisms of aging, should come first. Only after complete restoration of the function and morphology of the skin are other types of correction permissible. After such corrections, full rehabilitation of the area is again necessary. This is how real, lasting results can be achieved.

First published: KOSMETIK international journal, No. 2 (56) / 2014, pp. 30-33