How can I get rid of my smile lines?

Thank you for the question.  You submitted some good photos, and ask if Juvederm can help you with the smile lines as you state that makeup tends to in them.

I can certainly give you some assistance with this question. I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been practicing in Manhattan and Long Island for over 20 years, and I use a lot of fillers for smile lines in situations like yours. In the absence of a physical examination in getting the depth of those lines, I would be cautious about using dermal filler to help those smile lines. When you say makeup is getting in, we need to examine if this a line can really benefit from a filler. You think about where fillers are placed when it comes to nasolabial folds which are sometimes referred to us as parentheses.

When someone is a little older and they lose volume, this material is placed deep within the skin in the dermis. When you think about the skin, the epidermis or dermis, you are dealing with a couple of millimeters which are very thin, and then below that is often where fillers end up to help support some of the volume loss associated with facial aging where bone, muscle, fat, and soft tissue are lost. In your situation, we are dealing with something which is shallower, so my concern is filler is placed to try to improve that shallow level of the dermis where the lines start to go in a little and the makeup tends to collect, will you end up with a ridge? It is a possibility, as well as putting a very low molecular weight or viscosity such as hyaluronic acid filler, but then the question is will it make enough of a difference?



Sometimes with patients like you, we will try to do something like epidermal softening and blending, something like Hydrafacial which is basically a combined approach of microdermabrasion with glycolic acid.  Often, I will just tell people that it is fairly superficial and it is only an issue related to makeup, but it is not a facial aging issue or it is not taking away from your overall facial structure. Wait to do any treatment because I think if your expectation is makeup will not go to that area, that will be tough because this is an area which naturally just folds in, and this also accounts for basically lines in the cheeks when people smile. These lines tend to be more dynamic, which is treatable with an injectable that relaxes muscle like Botox™, but these are natural lines consistent with the facial anatomy.



I think you need to meet with a doctor and have a consultation. Learn about your options, and see what you are ready to define as success because you want to be able to eliminate the lines. I always explain to patients that improvement is the goal, and it is not always about elimination because you can’t erase lines with laser, surgery, radiofrequency, or microdermabrasion, you name it - it is always about improvement. Meet with doctors and learn about improvement so you can come up with a solution sustainable for you. I hope that was helpful, I wish you the best of luck and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Based on the photos provided, superficial Juvederm injections can certainly be used to help hide the lines that concern you. In your case, only a very small amount of filler will be needed to eliminate the lines and leave you with a smoother look in this area. It is important to choose an experienced board certified plastic surgeon. Best of luck. James Lee

A fine line filler such as Belotero® may be more appropriate for superficial smile lines. In addition, consider a less-heavy makeup formulation, such as a solid concealer for blemishes followed by loose tinted powder, so that make-up doesn't 'sink" into my lines. For more skin care and makeup tips, visit our Twitter Feed @MiamiSkinIns