Best Ways to Treat Vertical Lines Around the Mouth?

I am in my 50's and the deepest lines on my face are in the mouth area, vertical lines above the top and bottom lips. I am a non-smoker, light-skinned caucasian female. It has been suggested to use Fraxel over the entire face gradually lightening the intensity as we go up the face and later use a filler if needed for the smile lines. Is there something else at this time more effective and possibly with less down-time than Fraxel? I bruise easily. Do you suggest eating or taking something before a procedure to reduce the bruising?

Doctor Answers 10

Upper lip wrinkles & lines

One of the more disconcerting changes with aging often involves the upper lip. As a result of time, sun, heredity factors and sometimes exposure to cigarette smoke, small vertical lines and creases often form from the lip edges. When coupled with shrinkage of lip tissues, this creates an undesirable appearance for many patients. Assuming that smoking has been discontinued and sunblocks are wisely used, then the options include:

(1) "resurfacing" (wounding) the upper lip with lasers, dermabrasion or a chemical peel. All are designed to some degree to create a wound in the epidermis & dermis, and stimulate the skin to produce new skin cells, including collagen and epidermis,  ie, brand new skin which aims to be smoother and healthier than the old skin. Some downtime is required. 

(2) "fillers" which add volume and help soften lines and tissue loss.  Examples include Restylane and Juvederm type products. There is usually no downtime with this but it  has limited effects on fine wrinkles. 

Both (1) and (2) compliment each other. A consultation with a qualified physician to help determine the pros and cons of each individual patient's needs is a good first step!

Louisville Facial Plastic Surgeon
5.0 out of 5 stars 51 reviews


Botox in tiny amounts help prevent the dynamic wrinkling (the cause of the lines) and thinner fillers like Restylane Silk can fill in the #LinesAroundTheMouth and lasers or radio frequency or infrared treatments can tighten the skin. Restylane® Silk has recently been approved by the FDA for release in the United States. It’s the first and only approved product specifically designed for smoothing wrinkles and lines around the mouth, as well as replacing lost volume. The BioSpa by Pacific Center for Plastic Surgery is now offering Restylane® Silk to patients desiring lip enhancement.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 102 reviews

Vertical Lip lines

There are many effective ways to address your concerns, ranging from office procedures to minor surgical skin procedures.

Fillers help to add volume to the white line, where lip liner is usually placed. This helps to soften the vertical lines, but does not always flatten them completely. Filling this area also provides the illusion of fuller lips without actually increasing lip volume, which many patients like.

Laser resurfacing (Fraxel included) or dermabrasion is often needed with deeper lines to help the wrinkles flatten more completely. This is important for many patients that have problems with lipstick bleeding into these lines.

Staying away from aspirin containing products, over the counter cold medicines, many herbal supplements is critical for avoiding bruising. Some patients receive benefit from taking arnica and bromelaine tablets after procedures to diminish bruising or speed up healing.

Richard W. Westreich, MD
Manhattan Facial Plastic Surgeon
5.0 out of 5 stars 38 reviews

Lines around the mouth are best treated with co2 laser and fillers such as restylane silk or belotero in combination

fillers such as restylane silk, belotero, or juvederm can work well to treat lines above around around the mouth but the best first option is laser resurfacing or deep peels to induce collagen production.  newer superficial radiofrequency devices such as sublative or viva and microneedling help as well and are less invasive.  I suggest going to a well trained cosmetic dermatologist with expertise in lasers and fillers.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
5.0 out of 5 stars 132 reviews

There are many options that can be used here for these lines around your mouth

Thanks for your question and in 2015 there are many options that can be used here for these lines around
your mouth. The non-ablative fractional lasers will help here, and will require a series of treatments, with
minimal downtime to give some very nice results. Four to six treatments over 4-6 months is usually
required and many of the wrinkles in this area will improve. The ablative fractional lasers work faster, but
have more downtime. There are many kinds of ablative fractional lasers – we use mainly the Lumenis
UltraPulse or AcuPulse, the Ellman Cortex, and the Syneron Core. We also have the sublative RF fractional
devices, the Syneron eMatrix and the Venus Viva that has shown great results in treating wrinkles, and
those above the lip.. The new Venus Viva is showing similar results. And now there are RF microneedling
devices, such as the EndyMed Intensif, and this also works well with wrinkles, again with minimal
We also use fillers and toxins here. The two fillers used the most in 2015 are Belotero and the newly
approved Restylane Silk – a new filler, with proper injection techniques, can give very nice results.

Michael Gold, MD
Nashville Dermatologic Surgeon
4.0 out of 5 stars 16 reviews

Fraxel® isn’t your only option

Depending on how pronounced the lines around your mouth are, Fraxel® might be overkill. If you have other issues you want to address in addition to those smaller wrinkles, like uneven skin tone or age spots, then Fraxel® might be a solution. If your main concern is just those particular lines, there are definitely other options. Microdermabrasion or even chemical peels offer resurfacing solutions that can minimize the look of fine lines and wrinkles with far less downtime. And of course, a combination approach is a great solution for getting rid of “smoker’s lines”—BOTOX® Cosmetic injections combined with dermal fillers treats wrinkles in two different ways for a smoother, younger look with zero downtime.

Best way to treat vertical lines around the mouth includes: Fraxel, Botox and Fillers.

Best way to treat vertical lines around the mouth includes: Botox, Fraxel and Fillers. I first recommend to do Botox (done right above the border of the lip) in order to minimize further movement-induced worsening of the lines. Then, I perform a series of Fraxel laser treatments for fractional resurfacing and wrinkle effacement, which is highly effective. Any remaining lines, I then fill in with a very smooth fine filler such as 'Restylane fine lines'. The final result is typically a very dramatic improvement/resolution of the lines around the mouth. 

Treatment of Fine Lines Around The Mouth

Fine lines around the mouth can be challenging to treat. There are several treatment options depending on how fine/severe the lines are. Chemical peels can help with very fine lines. The Fraxel laser can help with moderate to severe lines. Botox/Dysport can help with not only improving them but also with preventing their progression. Very limited amounts of fine, soft fillers such as Belotero can help as well.

Ava Shamban, MD
Santa Monica Dermatologic Surgeon
4.0 out of 5 stars 9 reviews

A combination approach usually works best.

Since there are several contributing factors to facial aging—changes in collagen production, sun damage, volume loss, etc.—sometimes it takes a combination of treatments to resolve the lines that appear. For smoker’s lines, Fraxel® can be a great solution. Yes, there is some downtime, but the long-term results are going to be superior compared to a short-term treatment. Injectables are another option, either in addition to or instead of Fraxel®. To minimize bruising, be sure to stop taking all blood thinners about a week ahead of time (aspirin, Vitamin E, and even garlic are all blood thinners) and use cold compresses before and after your injections.

Consider fraxel repair or fillers

It sounds like you might be the perfect candidate for either fraxel repair or  Fillers.  However if you do bruise, I suggest you stop taking anything that would thinn your blood out like asprin.   I also recommend you take homeopathic arnica montana that has been clinically proven to reduce bruising and swelling after surgery.  Fraxel repair can signifiacntly reduce the lines around your mouth.  Lastly a touch of botox can relax the muscles around the mouth improving lines.

Cameron Rokhsar, MD, FAAD
New York Dermatologic Surgeon
4.5 out of 5 stars 34 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.