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 15


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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.

Upper lip wrinkles & lines

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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!

Donn R. Chatham, MD
Louisville Facial Plastic Surgeon
5.0 out of 5 stars 75 reviews

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

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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. 

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Vertical Lip lines

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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
4.9 out of 5 stars 55 reviews

Vertical lines around the mouth

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Each patient is different, but in general, vertical lines around the mouth can be treated in a variety of ways. Most lines can be improved with hyaluronic acid fillers (Restylane, Restylane Silk, etc), but these are a temporary solution. Skin resurfacing procedures such as peels or lasers can offer a more permanent solution, but these do require some down time, depending on how aggressive the treatment is. Generally, the more aggressive the resurfacing treatment is, the better the result.

Using a good skin care regimen with a medical grade cleanser, toner, exfoliant, moisturizer, and sun screen is also helpful.

A consultation with a board-certified physician specializing in facial aesthetics is always recommended in order to obtain an individualized treatment plan. 

Matthew Richardson, MD
Frisco Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

Treating "smokers' lines" of the upper lip with laser, fillers, microneedling etc. in my NYC practice and new technology

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It's quite possible to smoothen, but usually not eliminate, these creases caused by the underlying muscle contraction of the mouth. Botox can help reduce the pulling on the skin from the muscle when pursing the lips, and laser resurfacing can improve sundamage and creases. Fillers can be injected underneath the lines, such as Juvederm's Volbella, and Belotero. 

Infini microneedling with insulated needles, delivers radiofrequency energy into the tissue under the surface of the skin and with three monthly treatments, there can be improvement in these lines. The healing is faster than fractional ablative laser but in some cases it may take more days to heal compared with fractional nonablative Fraxel laser. This is our most recently added technology in our NYC practice for smokers' lines.

Arnica montana is often recommended to minimize swelling and bruising post procedure.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Best Vertical lip lines treatment

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Thank you for your question. Smoker's lines develop from loss of collagen and elastin in addition to age appropriate volume loss in a highly mobile area like around the mouth. The treatment consists of the following: 

1. The simplest and not always that effective is botox (for muscle activity) 

2. dermal fillers like hyaluronic acid (Juvederm/Restylane)  and this repletes the volume loss 

3. For collagen and elastin production you need laser resurfacing, the best non invasive option is Ultherapy enhanced, and it can be isolated to just the around the mouth area. the other option with a slight downtime, need to be done on the whole face as your mouth will look younger than the rest of the face and will not be flattering. 

Sometimes it takes a combination of all three.  Fraxional laser skin resurfacing not Fraxel  is great for skin rejuvenation and it doesn't cause bruising just few days of downtime with redness and swelling. Fraxel (CO 2) treatment is very aggressive and had a significant downtime, bruising with that should be the least of your concerns.  Almost all people accept a little bit of bruising for 3-5 days in order to improve their appearance, Best, Dr.Avaliani

Anna Avaliani, MD
New York Physician
4.8 out of 5 stars 14 reviews

Addressing perioral wrinkles

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Thank you for your question. We utilize a few different treatments to help treat fine lines and wrinkles above the upper lip and below the lower lip, which often time result due to volume loss, skin aging and years of sun exposure. Injectable fillers can be used very effectively and precisely to reestablish volume in the lips (i.e. Juvederm) and fill in wrinkle lines (i.e. Restylane Silk, Belotero or Volbella), with little to no downtime. Resurfacing modalities (i.e. dermabrasion, chemical peels and laser therapy) are often used as well to help build collagen and elastin within the deeper regions of the skin while removing the superficial, worn out layer of the skin surface. The new skin that develops in its place is smoother, less pigmented and more youthful. There is some down time associated with these treatments, however. Proper skin care thereafter is imperative to maintain the quality of the new skin. A consultation with an expert in facial rejuvenation/facial plastic surgery will allow for a proper assessment of what treatments are most suitable for your individual needs.

Vertical Lines Around Mouth

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I would suggest filling of the fine lines with a dermal filler like Juvederm Volbella and consider a resurfacing procedure if the filler has not achieved desired treatment outcome on follow up.  Hope this helps.

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

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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
3.9 out of 5 stars 17 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.