Perioral Rejuvenation in Aesthetics: Review and Debate

Perioral rhytides are a common reason for presentation to the cosmetic dermatologist. Various treatment options exist, and it can be challenging to determine the optimal technique to use in a given patient encounter. We herein provide a review article highlighting various treatment options in the correction of perioral rhytides, focusing on the roles of neurotoxin, filler, microneedling (with and without radiofrequency), fractional resurfacing (nonablative and ablative), and fully ablative lasers, with a brief mention of deep chemical peels. For each modality, we review the evidence behind the specific technique, its advantages and disadvantages, post-procedural effects, expected downtime, as well as the onset and duration of desired effects. Despite longstanding debate regarding the "best" modality to use, we instead propose that the best approach is a combination approach which takes into account he patient's treatment goals while staying consistent with the expected amount of downtime. Importantly, we share clinical pearls based on the senior authors direct patient experience as Director of Laser and Cosmetic Dermatology at University of California, San Diego (UCSD).