Perioral Wrinkles in the 70s: C-Shaped Linear Lines with Minimal Sagging and Juvgen Autologous Dermis Regeneration

a. A female patient in her early 70s whose main concern was not facial sagging, but rather C-shaped linear wrinkles extending from the nasolabial fold down around the mouth.

b. Taking into account both her facial anatomy and her personal treatment preferences, fillers were omitted, and Juvgen Autologous Dermis Regeneration was performed.

c. When addressing perioral wrinkles, it is essential not only to assess wrinkle depth but also to examine muscle movement, underlying soft tissue, fat distribution, and peri-oral skeletal/structural protrusion.

Hello. I am Dr. So-hyun Park, Head Director of Samsung B&S Clinic.

When people think of perioral wrinkles around the mouth, they often picture marionette lines caused by facial sagging. However, even among individuals in their 70s, the appearance and underlying causes of perioral lines vary significantly depending on the degree of tissue sagging and the unique anatomy around the mouth.

Today, we will review the case of a female patient in her early 70s who showed relatively little sagging in the lower face, but exhibited prominent C-shaped linear wrinkles extending from the nasolabial folds toward the mouth corners.

This content details the clinical course of a specific patient and does not imply generalized outcomes. Treatment results and recovery timelines vary depending on individual skin condition, facial structure, and treatment modalities.

1. A Case Where Linear Perioral Wrinkles Were More Prominent Than Sagging

With age, descent of the buccal fat pad or prominent marionette lines often creates an uneven, irregular contour across the lower face.

However, this patient presented differently from this conventional pattern of aging.

Her jawline and lower facial contours were relatively well-preserved for her age, and sagging of the lower cheek or buccal fat was not severe. Instead, her primary concern was several fine-to-medium linear creases connecting from the nasolabial folds toward the sides of the mouth.

These lines wrapped around the mouth in a continuous arc, forming distinct C-shaped perioral wrinkles. Although her entire face did not appear heavily sagged, the concentrated clustering of lines around the mouth contributed to a tired or worn expression.

2. Why Wrinkles Form Around the Corners of the Mouth

Approximately 1 cm lateral to the oral commissure lies the modiolus, the convergence hub of several facial expression muscles. Here, multiple dynamic muscles intersect, repeatedly engaging during everyday facial movements such as speaking and smiling.

Medial to the modiolus, the tissue is relatively firmly tethered to the skin, resulting in less movement. In contrast, lateral to it, tissue exhibits greater mobility due to the presence and movement of superficial fat.

At the boundary between this relatively fixed zone and the highly mobile zone, the skin folds repeatedly with oral movement, creating persistent linear indentations over time.

In this patient's case, the skin and underlying dermal support around the mouth were comparatively thin and fragile. Combined with dynamic mechanical movement, this anatomical transition zone led to persistent C-shaped creases descending from the nasolabial area toward the mouth corners.

3. Differentiating from Classic Marionette Lines

Visible lines around the mouth do not all stem from the same etiology as classic marionette lines.

When lines near the mouth deepen, one might instinctively think of dermal fillers or thread lifting for that region. However, before deciding on a therapeutic course, it is crucial to confirm whether tissue ptosis (sagging) is truly the primary culprit.

In this patient, tissue descent in the marionette zone was not the primary driver of her perioral lines. Consequently, simply filling the depression with volume held clear limitations; depending on the placement depth and product volume, it could even weigh down the perioral area or create an unnatural fullness.

Thread lifting also depends heavily on the vector of tissue repositioning. Given her facial structure, standard lifting vectors were unlikely to adequately resolve these superficial C-shaped folds. Ultimately, addressing perioral wrinkles requires differentiating the precise location, mechanism of formation, and perioral projection profile.

4. Understanding Facial Architecture: The Rice Bowl and Dough Analogy

Patients who develop C-shaped perioral lines often exhibit a facial architecture where the perioral mound projects forward relative to slightly depressed adjacent areas.

Consider placing an inverted, convex rice bowl onto a flat surface. The center protrudes forward while the perimeter sits lower. If you press that bowl into soft dough, an indentation naturally circles the outer rim. In the human face, a similar boundary crease can establish itself along the transition zone between the projecting perioral structure and the adjacent depressed tissue plane.

In such anatomical presentations, subtle chin or pre-jowl filler can sometimes be considered to harmonize depressions and soften relative perioral protrusion. However, whether to introduce filler and the volume required must be meticulously determined after examining individual bone structure and soft tissue coverage.

5. Choosing a Treatment Approach Free from Filler Hesitation

In this consultation, we considered treating the linear creases with Juvgen Autologous Dermis Regeneration, alongside potentially placing minimal micro-filler in localized structural hollows if anatomically beneficial.

However, the patient felt hesitant and reluctant about receiving filler injections. Honoring her preference, we avoided filler entirely and proceeded exclusively with Juvgen Autologous Dermis Regeneration.

A comprehensive treatment plan must align anatomical assessments with the patient's desired degree of change and personal comfort level regarding specific procedures.

This patient did not seek a drastic change in overall facial contours; rather, she wanted to preserve her natural features and expressions while gently softening the concentrated linear wrinkles around her mouth.

6. Immediate Post-Procedure Presentation and Clinical Course

In photographs captured immediately following the Juvgen Autologous Dermis Regeneration procedure, a noticeable softening of the C-shaped perioral lines originating from the nasolabial fold was observable.

Importantly, however, these images reflect immediate post-treatment status rather than final long-term outcomes. Temporary erythema (redness) and needle marks may be present immediately following treatment; the intensity and resolution speed of these transient signs vary by individual.

With Juvgen Autologous Dermis Regeneration, neocollagenesis generally initiates around 2 weeks post-procedure, progressing steadily over the subsequent 1 to 2 months to yield gradual tissue restoration.

Therefore, it is essential to distinguish immediate post-injection swelling from progressive biological remodeling, recognizing that long-term outcomes cannot be judged by immediate photos alone.

7. Looking Beyond the Wrinkle to Analyze Anatomical Architecture

Even within the same age group in their 70s, perioral lines arise from diverse anatomical factors.

Some individuals present primarily with buccal fat pad ptosis, others with deeply shadowed marionette folds. In contrast, others—like this patient—retain well-defined jaw contours yet develop C-shaped perioral lines stemming from differential mobility around the modiolus and localized perioral structural protrusion.

Accordingly, assessing perioral lines must encompass more than superficial wrinkle depth. It requires evaluating the confluence of perioral musculature, dermal-to-subcutaneous tissue adherence, fat compartment distribution, and relative maxillo-mandibular projection.

Rather than artificially altering overall facial harmony, the goal should be preserving an individual's natural structural identity while refining localized concerns. Especially for perioral rejuvenation in the 70s, where aging and structural anatomy intersect, treatments should not be selected by wrinkle labels alone, but through tailored, meticulous anatomical consultation.

Head Director Official Blog

In the original video below, Dr. So-hyun Park explains the anatomical basis of C-shaped perioral wrinkles in the 70s and the clinical rationale for choosing Juvgen Autologous Dermis Regeneration.

Frequently Asked Questions

Are all perioral wrinkles in your 70s caused by skin sagging?

No. While ptosis is common, muscle dynamics and facial architecture play significant roles. Differential movement around the modiolus (the oral commissure muscle hub) and structural perioral protrusion can cause repeated skin folding, producing distinct C-shaped linear wrinkles even without severe tissue sagging.

Are dermal fillers mandatory for treating C-shaped perioral wrinkles?

No, fillers are not essential. While micro-fillers can theoretically balance adjacent depressions, improper placement or volume risks adding heaviness around the mouth. Taking patient comfort into account, Juvgen Autologous Dermis Regeneration can be performed effectively on its own.

When do results appear after Juvgen Autologous Dermis Regeneration?

Neocollagenesis typically begins approximately two weeks after the procedure. While individual responses vary, progressive structural improvement occurs over 1 to 2 months as new collagen matures. Mild redness and injection marks immediately post-treatment are temporary.

How do C-shaped perioral lines differ from marionette lines?

They differ in underlying etiology and anatomical presentation. Marionette lines primarily stem from soft tissue descent and buccal fat sagging. In contrast, C-shaped perioral lines arise along the boundary of mobile expression muscles and projecting perioral anatomy, creating curved linear creases running from the nasolabial fold toward the mouth.