How a Plastic Surgeon Treats Lip Lines

people come into my office all the time concerned about vertical lip lines around their mouth it's an area of great distress for many people you may be experiencing these lip lines as well and you may have looked in the mirror this morning and said geez I'm looking older because of those lip lines well today I'm going to discuss what causes them and how to treat them stay tuned so let's talk about what causes them most common cause of upper lip lines at least in the past has been people who smoke so smokers are pursing their

lips and they're smoking and they also are causing some lack of oxygenation of the tissues around their mouth when they do that the smoke constricts blood vessels and also has some toxins and other effects on the tissues themselves so we see lip lines occur particularly in people who are heavy smokers but the incidence of people uh smoking heavily is diminishing over time because of the risk involved in smoking but we still see them related to smokers and I still see people who are heavy drinkers also can have uh a lot of lip lines and that's

probably again just because the the effect of alcohol on on their skin and their tissues also has a huge effect on causing atrophy of the tissues and their lips tend to become thin with deep lines around their mouth very common reason for lip lines that occurs and is not really appreciated very often is that the teeth the teeth can be small or recessed and when there is recession of the teeth as we age there's going to be a change in the skeletal uh morphology of our our face with time the muscles that are around the

the lip which is the orbicularis orus muscle tends to contract and conforms to the new recession of the teth so the teeth normally are structural supports for the soft tissue overlying the teeth which is of course the the lip and as we age this there's a kind of a collapse of tissue uh inward as the muscles uh also contract inward so that really is a dental issue Orthodontics uh can help rearrange the teeth so that the bite is not recess receding and supporting the lip of course that is uncommonly treated that way especially in older

people because they think well they're beyond the point of where Orthodontics is going to help them but from an aesthetic point of view it's very important so we a lot of techniques are used to try to camouflage this recession that's something we should have to we have to keep in mind another reason for uh lip lines of course is repetitive pursing of the lip and some people just have a tendency whe the way they talk or or if they drink through a straw or they uh it's just a a habit of theirs where their lips

purse every time they speak and by pursing their lips they start forming these deep lines around their mouth an additional reason is of course sun damage to the skin and over time aging also causes atrophy not only of the fat underlying the skin but also the orbicularis orus muscle becomes atrophic so there's some good evidence that the muscle itself becomes at trophic and as we age there's this upper lip tends to drift down from the below your nose which is the subnasal area and this lip starts to lengthen with time again these are Dynamic changes

that occur over many many years but that also contributes to these these vertical lines that we see so it's not always the smoker out there who has lip lines I have family members who have relatively small teeth and they have lip lines and they never smoked in their lives so it's it's an interesting problem now the question is how do we address these lip lines how can we uh prevent this these changes from occurring well sometimes we can't prevent it entirely because uh it it's it's just a normal evolution of Aging but for instance if

you are a sun worshipper or you drink heavily or you smoke you have to stop doing those activities because those activities will contribute to the Aging of the not only the lip but the rest of the face you can also use sunblocks up here uh and that's a very important uh aspect of of preventing sun damage to around your mouth which will of course prevent actinic damage which can lead to those vertical lines so the question is how do we treat this problem because patients come in all the time and they're very concerned about the

way their their peroral area appears uh what can you do for my lips they asked well first of all let's establish something women are more commonly complaining about their lip lines than men and there's a good reason for that men typically shave around their their upper lip and by shaving they are doing a abrasion of their skin on a daily basis so they're actually doing micro therm abrasion here and by doing that it toughens up the skin and actually actually removes some of those fine wrinkles in addition men have thicker skin in general you know

if you start out with thicker skin you have fewer upper lip wrinkles in the end women's skin tend to be thinner the dermis and their epidermis is thinner and therefore it's more prone to developing these vertical lines so once you have those lines then there are different approaches to trying to treat them one approach is to use botolinum toxin like botox and you can use tiny amounts of Botox dilute Botox can inhibit some of those muscle contractions not to the point where you can't suck through a straw or talk but to the point where you're

inhibiting some of the contraction around the mouth as the lip is pursed whether they're eating or talking or or drinking through a straw you want to weaken the muscle slightly you don't want to do it to the point where you obviously are impaired in terms of you're talking or you're eating and by the way I would not recommend using something that what's called like a longlasting Botox effect which is like daify because daify is a Botox that can last six months so if they if by chance the botox is too powerful and it causes some

inhibition of the muscle contraction you have to live with that for six months or or longer whereas if you use botox it only has a lifespan of about three months so if there's a if there's an overshoot so to speak of the amount of medication in injected it'll shorten the time where you will get recovery so I wouldn't use this long lasting Botox around the mouth for sure now the second thing is some people try to use use micro needling with radio frequency if it's done in a conservative Manner and done maybe sequentially in several

sessions you can improve the vertical lines on your upper lip uh with that technique however if the Micron needling procedure is done in an aggressive manner it could cause some atrophy of not only the fat but the M underlying muscle and that can only worsen the problem so whoever is doing this micro needling really has to be ultra conservative about the power that's delivered through the micro needling device and that can sometimes has to be gauged and and um you know brought they have to tune it down so that they don't overshoot again in terms

of delivering too much energy and causing undesirable second secondary effects another approach to improving upper lip lines particularly is to use laser resurfacing now laser resurfacing has its pros and cons as well so first of all uh you can use a CO2 laser or you could use an herum yag laser what I've seen is that a CO2 laser can sometimes deliver too much heat to the underlying uh cells particularly the pigmented cells in your upper lip and cause a depigmentation of the lip area so if you treat just around the lip area here in in

what's called an aesthetic unit if you use a CO2 laser and you don't treat the rest of the face there may be a disparity in terms of the color of the skin here versus the skin around your mouth this might look lighter in color again it has to be done with in experienced hands uh in order to get a result that blends this area with with the adjacent areas I prefer using what's called an herum yag laser which does not deliver as much heat to the to the tissues as a CO2 laser and it can

also oblate these deep vertical lines around the mouth the only real downside of either these laser treat of either laser treatments is that the patient may have a long uh recovery period following this treatment so I always say the deeper the line the deeper the treatment the longer the recovery so if you have very deep lines you're going to have to use more energy to flatten those lines out and therefore the recovery period is going to be much longer the other option is to use what's called a fractionated laser which will have a more rapid

healing period of time but it won't also give you the same type of result you'll get with what's called an ablative laser it will improve the lines but it may not eliminate the lines there's a faster healing period with a fractionated laser but it doesn't always deliver the same results some doctors would also recommend chemical peels around the mouth and this was commonly done for many many years prior to the evolution of of lasers doctors would use phenol peels to smooth out these lines and it was very very effective to smooth out those lines the

problem with phenol was that it penetrates the skin very deeply it can give a kind of a almost like a plasticized uh texture to your skin and uh and it can depigment the skin so it can again lighten the areas that are treated so if you just treated this as one aesthetic unit and you don't treat the rest of the face it can be this disparity between the lip and the adjacent areas so I wouldn't recommend phenol personally I I think it's there's a chance you'll get depigmentation the other option is to use glycolic acid

which is another type of chemical peel which is of course much milder but again it may have to be done sequentially multiple times to achieve the similar result that you'll get with a laser so the laser to me is the gold standard in terms of ultimately getting uh eliminating or or smoothing out wrinkles on the upper lip however the recovery time can be long and arduous at times and it could take up to sometimes six weeks to two months before the pink areas dissipate entirely in the inum of course you can wear makeup and uh

cover those areas of course another treatment for vertical lines on the upper lip are fillers which I didn't mention right from the start because that's of course a temporary fix now fillers can be used but they have to be used in a very dilute way so sometimes you can take the filler or the the practitioner whether it's a nurse or a doctor and they have to thin it out they have to thin down that hyaluronic acid gel and thin it down uh to the point where it flows very easily and some some of the fillers

now are coming are being introduced that are much thinner in in nature I know that uh wrestlin has come out with some and juviderm has come out with a few and there's also tsil which is red density has a few and I like some of those products that are already made in a very thin very less viscous way because you can fill very fine lines with these these dilute fillers the only downside of these fillers of course is that they don't last as long because the viscosity has been diluted down but they very effectively fill

in those lines and they don't leave lumpiness but they don't last that long so that's the downside of doing that and of course you have have to repeat it over and over again uh in order to maintain those improvements now there are home devices that are being promoted like dermar rollers and some people use them almost on a daily basis and they dermar roll over their skin with these dermar rollers I have a little reservations about that because I think that first of all it's not as sterile if you use it repeatedly the the dermar

roller you may have bacteria on there you're rolling you're creating micro punctures in the skin and you may end up with some localized infections uh from the dermar rollers I'm not a great fan of those home devices for that reason and of course the other problem with a deral roller is that the depth of penetration is only uniform across the whole spectum of the lip there's no way to to change the depth uh based upon uh the thickness of your skin so that may change with time an additional home remedy of course would be to

also use retina something retinoid products can thicken the collagen on underneath your skin and that can improve the quality of the skin and thicken the skin and diminish some of the fine lines and wrinkles around your mouth but again you can't use retinoid uh products if you're going in the sun when you take retinoids or use retinoids I should say doesn't jive with a lot of sun exposure and of course even if you you aren't using retinoid you need to use sunblocks on a regular basis around your mouth every day if you can to prevent

the sun damage that occurs over many years this is basically the summary of how I approach patients with vertical lip lines or lipstick lines if you want to call them that today I've given you an overview of lip lines what causes them how to prevent them how to treat them I hope you found this to be informative and you have the right questions to ask your practitioners and if you have any further questions please leave them below I'm more than happy to answer them and I look forward to seeing you in my next video