Q. I am in my 50s and my upper lip is disappearing. Is there anything I can do besides injections?

A. Actually, as we age our upper lip (the skin between the red part and the nose) gets longer – sometimes considerably longer, to the point where upper teeth cannot be seen with the mouth slightly open, as when young. When the skin part gets longer as described, the lip turns under.

The treatment is a “buckhorn” excision of skin just below the nose. In youth the distance between the nose and vermillion (the red part of the lip) is 1.4 to 1.6 millimeters. We have seen the distance increase to 2.5 millimeters.

The buckhorn excision removes the excess skin. Anesthesia is local and the scar is located just under the nose and is imperceptible.

Q. When I look in the mirror, I look sad or angry because the corners of the mouth turn down. Is there anything I can do about that?

A. The simplest treatment is to inject Botox or Dysport just below the corner of the mouth and in a specific place on the jawline. This relaxes the depressor anguli oris muscle (DAO), which naturally pulls the corners down. This lasts about three to four months.

A permanent remedy is to excise a carefully measured triangle of skin just above the corners of the lip. This elevates the corners of the lip into a more “happy mouth.”

An alternative procedure, if the patient also has deep Marionette lines (the depressions below the corners of the mouth), is to extend the excision downward, also removing the excess skin lateral to the marionette line. This takes care of the droopy mouth corners and the deep marionette lines. This procedure is also done under local anesthesia.

Injectable fillers can diminish marionette lines and, if needed, volumize any loss of volume in the cheeks. Fillers might be needed in addition to the minor surgical procedures mentioned, since the questions above involve the aging face, and this always involves some facial volume loss of both fat and bone.

Q. What is the treatment for earlobes when the pierced ear hole has enlarged too much?

Under local anesthesia, the edges of the hole must be cut out generally all the way through the lower border of the earlobe. Then, the open edges of the excision are sutured up to close the hole completely. The ears can be re-pierced in six weeks.

E. Ronald Finger, MD, FACS is a board certified plastic surgeon with offices in Savannah and Bluffton. fingerandassociates.com