The eyes are the first to go. Next, the mid-face region stretching from the nose to lips. The drooping happens so gradually that it might take a sec before you notice things are going South.  The change isn’t Earth-shattering, to be sure—but it’s enough to make you realize that this aging thing is now officially in full swing.The crow’s feet, the laugh lines, the age spots…all expected. But when the hands of time start making their mark on other, unanticipated areas—like the lips—it can be especially traumatic. Especially since the lips are front and center!

QUIZ: Find Your Best Lipstick Color

Full, plush Angelina Jolie-esque lips are a sign of youth, vitality—and they’re also super-seductive. The plumper your pout, the higher your estrogen hormones. So when they start to lose their za-zing it’s more than an interruption in your beauty routine, it can cause a seismic self-esteem shift. “The corners of the lips droop, the upper lip elongates, the lower lip drops and we actually lose volume in the lips and midcheeks,” says YouBeauty Cosmetic Surgery Expert, Arthur Perry, M.D.

Why Me?

Other than moisturizing and painting your lips, have you really given much thought to them?Think of all the movements lips make in a single day: smiling, kissing, talking, sipping from a straw, opening wide to yawn, sneeze or eat. All these lip calisthenics contribute to wrinkling. Then there’s the sun, which we all know causes all sorts of deleterious consequences to our skin. And if the surgeon general’s warnings aren’t enough to get you to stub out your cigarette, then it’s unlikely the threat of fine lines and bleeding lipstick will have you ditching the habit.

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And that’s just the consequences of your lifestyle on your lips.As we age, our body produces less collagen. Think of collagen as the stuffing in your mattress. After years of tossing and turning, it just doesn’t have the bounce it once had—nor do those mattress springs miraculously regenerate. The same can be said for the lips.“As we age, our mouth loses volume, which leads to thinning of the lip and flattening of the cupid’s bow,” says Manhattan dermatologist, Meghan O’Brien, who’s also a consultant for Physicians Formula. One of the most effective anti-aging products for lips is an SPF-infused lip balm. But that alone isn’t enough. “SPF protects against skin cancer and brown spots,” says Dr. O’Brien. “But even without any sun exposure we lose lip volume over time.”

Stuff Your Face

For treating a loss in lip volume, there’s a simple solution: fill ‘er up! Luckily, there’s no shortage of volumizers that can be injected into lips. But that’s only half the challenge.Understanding the way the face ages is one of the key factors in successfully rejuvenating the perioral area, says Gregory Goodman, M.D., an associate professor at the Dermatology Institute of Victoria in Victoria, Australia. The aging of the lower face can be influenced by genetics and racial characteristics, and usually begins with the nose dropping back into the face and downward. As if that wasn’t enough, a change in the upper and lower jawbones causes the chin to tilt up. “These combined changes can lead to the well-known caricature of the chin meeting the nose in old age,” he says.So why should the chin and nose have any impact on your lips? One word: symmetry.

“Beautiful lips are certainly the ideal…but it must be kept within proportion to the rest of the face,” wrote Goodman in a paper published in this June’s issue of Cosmetic Dermatology. Age is also an important factor. “We are not trying to create a 25-year-old lip on a 55-year-old,” he says. “It would look inappropriate, no matter how well it’s achieved, since it would be out of synch with the rest of the face.”

QUIZ: See Your Face Perfectly Symmetric

Not Just Any Quack

We’ve all seen women with the accursed trout pout. This is what happens when practitioners inject too much product into the wrong parts of the lip. There’s an artistry involved in injections—the vermillion border around the lips and the cupid’s bow, the ratio of the top to bottom lip all must be preserved.

To bring the lips back into proper and natural-looking alignment, Goodman recommends using a neurotoxin (Botox, Dysport, Xeomin) around the mouth to focus it “back into a neutral relaxed position.” That, in combination with a filler to restore volume—as well as consideration to the face’s overall symmetry—will lead to optimum results. In fact, when he had patients (average age, 52-years old) assess the changes to the bottom half of their face, they found that botulism toxin combined with hyaluronic acid and correct placement left their lower face looking up to 12 years younger. Not too shabby!

Buyer Beware

“Fillers are commonly used to rejuvenate the mouth area, but beware—their use is deceptively simple and too many doctors and even nurses are injecting them,” says Dr. Perry. “Plastic surgeons and properly-trained otolaryngologists, dermatologists and ophthalmologists are really the only doctors that should be injecting fillers.” Inappropriate use has resulted in deformities, infections and loss of skin. Fortunately such complications are rare, but the ‘trout mouth’ complication is very common and comes from an un-artistic doctor injecting too much filler in the wrong places.

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Hyaluronic acid is the filler of choice for plumping small lips and alleviating wrinkling around the mouth. More robust fillers such as fat (taken from another part of the body) or Radiesse are what Perry uses for fill the depression lines between the chin and jowls.“Fat may be the only safe permanent filler since the others contain plastics or silicones,” says Perry. “But temporary fillers are just that—temporary. If you don’t like the result, you’ll eventually return to your former appearance.”