What can be done about vertical lines above the top lip?

Question

I have a few vertical lines above my top lip. What is the best way to reduce or eliminate these lines?

Nelson Lee Novick, MD · Answer

The most effective way of approaching the vertical lipstick bleeding (bar code) lines above the upper lip is to address both primary causes of this common cosmetically troubling problem. Increasing overactivity of the muscles of facial expression around the mouth are the underlying cause. Repetitive overactivity of these muscles everntually leads to the "etching" of the overlying skin into the characteristic vertical lines you describe. (They similarly and quite commonly also occur below the lower lip, as well). So, in order to most effectively treat these lines, it is wise to both suppress the overactivity (not freeze) of the muscles encircling the mouth, which takes only a few microndroplets of Botox (or Dysport or Xeomin) to achieve. And, filler, can then be used to smooth the "etched-in" lines that have already form. Both procedures are quick and most often performed together in the same treatment session, which should take no more than five minutes or so in experienced hands. The results are typically quite gratifying. Make sure you consult with a board certified aesthetic physician with experience and expertise in treating this region, as this is not an area that should be left to novice injectors accustomed only to treating ordinary smile lines with simple Restylane or Juvederm. Best of luck.

Francis Johns, MD · Answer

Thank you for your question.It is difficult to know what would be your best option would be without seeing a photo. Juvederm or Volbella can be great options to fill in the lines. There is also the option of microneedling, which can help stimulate collagen and decrease the lines over time.

Jason Emer, MD · Answer

A combination approach would give the most improvement.  Fractional co2 laser or fractional RF treatments are usually best to this area in combination with fillers and/or botox. I suggest you see a cosmetic dermatologist for a formal evaluation. Best, Dr. Emer

Robert M. Tornambe, MD · Answer

babe68.   Options include fillers, chemical peel or laser resurfacing, or a combination.  Photos or consult needed to decide which would be best for you.  Be sure to consult with a board certified plastic surgeon. Good luck!

Nelson Castillo, MD · Answer

Thank you for sharing your question.  These "smokers" lines can be treated with a combination of Botox and thin dermal filler placement to help improve their depth relative to the surrounding lip skin.  Be sure to see an ASPS board certified plastic surgeon in consultation to discuss.

Sam Naficy, MD, FACS · Answer

Vertical lips lines may be treated with Botox or filler depending on the severity of the lines. For deep vertical lines that appear even when you are not making any expressions filler should be used very superficially to add volume and re-expand the tissue. Filler that is ideal for these areas would be Refyne or Volbella. For softer less visible lines a small amount of Botox may be used to lessen the strength of the muscle and help smooth the lines.

Ray Bayati, MD · Answer

Hello,
Generally, a soft (small molecule) filler such as Belotero, Restylane silk would do a good job in an experienced and artistic hand. 
some may call it "smoker lines" although majority of my patients never had history of smoking. some had strong family history of similar lines in parents or siblings. 
It is very important to know that sometimes few units of botox may be necessary. when I evaluate and find hyperdynamic muscles then I inject 2-4 units of botox at the same time. 
I suggest my patients if Botox works then they should have it every 6 weeks. that is the best way to prevent deepening the lines. It would cut back your needs for fillers in the future!
Hope that helped
best of luck.

Christian N. Ford, MD · Answer

Thank you for your question.  Vertical lip lines are very challenging to treat.  I find that a combination approach using Botox and fillers works best.  Volbella is a newly FDA-approved filler for perioral rejuvenation that might be a great option for you.  Please be sure to to see an expert injector for an in-person consultation to fully discuss your concerns and your goals and expectations in order to determine the best treatment plan.  Hope this helps and best wishes!

Christopher S. Jones, MD · Answer

I would try Volbella first. It is a very soft hyaluronic acid gel made for this area. If that falls short of your expectations, then tiny doses of Botox can help. Make sure that you are willing to put up with some weakened upper lip muscle which can make pursing your lips or drinking through a straw difficult. More lasting results would be obtained by laser resurfacing for shallow lines and fat grafting for deeper ones. Thanks for your question!

Steven Wallach, MD · Answer

Sometimes lip lines can be treated with tiny aliquots of botox or filler material. Sometimes laser or dermabrasion are helpful as well.

What can be done about vertical lines above the top lip?

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