摘要

Objectives: To present a compartment-respectful algorithm for treating aging lips and the perioral region. The goals are: (i) to classify lip aging (G1–G3) by surface and structure; (ii) to guide selection of instrument (cannula/needle) and filler rheology by objective; (iii) to apply a dual technique (microdepots + short threads) for projection and eversion; and (iv) to integrate multimodal protocols including collagen inducers, energy-based devices, polynucleotides, and exosomes. Introduction: Lip aging is multifactorial and affects women more prominently than men due to hormonal, anatomical, and lifestyle differences. Progressive changes—atrophy, inversion/eversion, elongation, perioral rhytids, and loss of elasticity—constitute a “metamorphosis” rather than an isolated defect. Treating only the lips without addressing the perioral zone risks incoherent results. Evidence supports a multimodal approach combining fillers, biostimulators, and technologies for natural, reproducible outcomes Materials / method: Patients with perioral aging were classified into G1–G3 based on lip shape, length, vermilion display, surface elasticity, and wrinkle depth. A structured algorithm guided treatment: surface therapies (polynucleotides, skinboosters, neuromodulators, peels, EBDs, exosomes) were combined with structural therapies (HA fillers, subcision, surgical lip lift). A dual technique was employed—deep cannula passes for safety and volume, fine needle injections for precision and projection. Over 80 patients were treated and evaluated using clinical photography and dynamic assessment. Results: In 60 patients, outcomes varied according to classification type. In cases graded predominantly by surface aging, improvements were most evident in skin quality, hydration, and reduction of fine rhytids. In those classified with structural deficits, results focused on projection, eversion, and vermilion definition. When both dimensions were integrated, a global perioral rejuvenation was achieved. Patient satisfaction was consistently high, with stable results documented up to 24 months. Conclusion: Aging lips undergo a progressive “metamorphosis” that cannot be addressed with isolated techniques. A structured algorithm based on classification ensures rational treatment planning and reproducible outcomes. The classification system directs whether to prioritize surface or structural interventions, while the algorithm guides the safe integration of fillers, biostimulators, and technologies. Together, they provide a framework for individualized, coherent, and superior aesthetic results.