correctly diagnose and treat – anti-aging the anti-aging guide anti-wrinkles anti-aging aesthetic medicine

correctly diagnose and treat – anti-aging the anti-aging guide anti-wrinkles anti-aging aesthetic medicine


The weakening of the face evolves insidiously and our role as a practitioner is above all to prevent the appearance of clinical signs of aging in the most fragile areas of the face: dark circles, cheek, oval of the face and of course lips.

For the lips, it is now possible to establish a precise clinical diagnosis with the “Lip Score ©” in order to propose a therapeutic protocol adapted to the stage of weakening of the lips. The Lip Score analyzes the various clinical signs of weakening of the lips: dehydration, loss of tone, loss of volume, wrinkles and fine lines on expression and at rest. Its aim is to allow patients to understand the physiological process of weakening of the lips and to react early in primary prevention. Indeed it is very difficult to make disappear wrinkles appearing at rest. It is therefore important to preserve the structure and architecture of the lips in order to maintain their tone, to limit the development of their weakening and to start the treatment as soon as a weakening of expression appears.

The lips are made up of three anatomical units: red lip, contour and white lip.

Each anatomical unit undergoes a specific and progressive weakening. There are four stages depending on the weakening of the different anatomical units of the lips.

– The red lip undergoes successively dehydration, loss of tone and loss of volume.

– The contour weakens and sags due to loss of support.

– At the level of the white lip, fine lines and wrinkles gradually appear, more or less numerous and deep on expression and then at rest.

As soon as the weakening score is established, the practitioner proposes an adapted and personalized treatment plan. It includes the different therapeutic techniques depending on the weakened anatomical unit. The priority techniques are “Fillers” based on hyaluronic acid which make it possible to reshape the red lip, the contour and the white lip. The purpose of hyaluronic acid injections is to restore the hydration of the lips, to consolidate the contour, to reduce wrinkles and to limit the development of embrittlement.

The different stages are visible with the Lip Score

Stage 1: reshape the red lip

At this early stage, only one anatomical unit is weakened: the red lip. The dehydration is slight and the loss of tone and volume is beginning. The treatment will consist of remodeling the red lip in order to preserve its hydration and tone in a very natural way. In the particular case of a thin lip, the desired effect is the eversion of the upper lip. In this case, it is necessary to inject the volumizing product at the level of the moist red lip in contact with the gum to obtain a push forward of the upper lip.

Stage 2: consolidate the contour

At this stage the dehydration of the red lip is noticeable. It causes a weakening of the lip contour. On the level of the white lip there are no wrinkles at rest, on the other hand with the expression certain wrinkles approach the outline. The treatment consists of injecting hyaluronic acid at the level of the contour to consolidate its structure. It should also be injected into the red lip to restore lost volume and hydration. At this stage, it is interesting to perform a mesolift at the level of the white lip in order to restore better skin tone and limit the development of embrittlement.

Stage 3: rebuild the architecture

The three anatomical units are weakened and the architecture of the lips is very weak. Dehydration and loss of volume of the red lip are very important. The lip contour is very fragile and no longer fulfills its protective role. At the level of the white lip, wrinkles and fine lines are present at rest and of course during expression.

The treatment must rebuild the architecture of the lips: smooth out the red lip, redefine the contour, reduce wrinkles and restore volume. It is possible to practice a mesolift (“deposit” technique) for superficial hydration and dermal remeshing with a cannula. Dermal remeshing is a skin rejuvenation technique that rehydrates and plumps the deep dermis more efficiently to give it better resistance.

Stage 4: loss of structures

At this stage the lips have lost their structures and make-up becomes impossible. Major dehydration of the red lip, significant loss of tone and volume. Contour definition blurred and crossed by many wrinkles. The white lip is weakened and the wrinkles are diffuse and deep.

The treatment is identical to stage 3 but requires more sessions and patience. The remodeling of the red lip and the contour require two to three sessions to repair the weakening then maintenance at least twice a year. At the level of the white lip, it is necessary to combine mesolift and dermal remeshing on an enlarged perioral zone (lip, cheek, chin, oval of the face).

The evolution of lip weakness

To remember

The lip area requires early diagnosis and preventive treatment to avoid the appearance of fine lines and wrinkles. The fillers available to us today allow us to obtain a rejuvenation and rehydration of the lips without adding volume. To establish your Lip Score: www.drmichelzbili.com/score-lips If you want to be a model during training, register online: http://www.ihta.fr

For further :

Caix P. The anatomy of the labial region involves the lips and the peri-labial zone. Annals of Aesthetic Plastic Surgery 47 (2002) 332-345.

Carruthers A, Carruthers J, Hardas B, Kaur M, Goertelmeyer R, Jones D, Rzany B, Cohen J, Kerscher M, Flynn TC, Maas C, Sattler G, Gebauer A., Pooth R, McClure K, Simone-Korbel U, Buchner L. A validated lip fullness grading scale. Dermatologic Surg 2008;34:S161-S166.

Zbili M. Classification of skin aging of the face and neck. Revitalization technique: mesolift. J Med Esth and Chir Dermatol. Vol XXXI, December 2004, 215-221.


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