Second smile line - how do you get rid of this? (Photo)

A horizontal line above the upper lip—sometimes referred to as a “second smile line”—can be due to a combination of skin elasticity loss, repetitive muscle movement, and volume changes in the surrounding tissue. If Botox did not improve the appearance, it may be that the line is more static (present at rest) rather than dynamic (caused by movement), or the injection sites/muscles targeted were not the main contributors. Treatment often involves a multi-modal approach, such as fractional laser resurfacing or microneedling with radiofrequency to stimulate collagen, small amounts of dermal filler carefully placed to avoid overfilling, and skin-tightening treatments to improve elasticity. In some cases, a combination of Botox with resurfacing yields the best results.

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. The horizontal line above the upper lip that you're describing can be challenging to treat, and it’s understandable that you're looking for the most effective approach. Here are some potential treatments and considerations for this specific issue:

1. Botox
Muscle Targeting: It’s crucial to ensure that Botox is injected into the correct muscles. The muscle responsible for these horizontal lines is typically the orbicularis oris. If Botox wasn't effective, it might be due to the injection not targeting the right part of the muscle or insufficient dosage.
Experienced Injector: Since you mentioned that your clinician hasn't seen this often, seeking out an injector with more experience in treating this specific area could be beneficial.

2. Filler
Technique Matters: Using a very small amount of filler with a fine needle and placing it strategically can help reduce the line without creating an unnatural look.
Material Choice: Certain fillers are more flexible and might blend better in this delicate area. A hyaluronic acid-based filler, for instance, can offer a more natural result.

3. Other Treatments
Microneedling with PRP: This treatment involves tiny needles creating micro-injuries in the skin to stimulate collagen production, and combining it with Platelet-Rich Plasma (PRP) can enhance results. It can help improve skin texture and reduce fine lines over time.
Laser Resurfacing: Laser treatments can help improve skin texture and reduce fine lines by stimulating collagen production. Non-ablative lasers are less invasive and can be effective for subtle lines.

4. Skin Care Routine
Retinoids: Topical retinoids can help improve skin texture and stimulate collagen production, which might gradually reduce the appearance of fine lines.
Hydration and Moisturizers: Keeping the skin well-hydrated can help plump up fine lines and improve overall skin appearance.

I hope this helps and best of luck!

Since the problem relates to muscular activity, Botox would be an appropriate treatment option. It is possible that the most appropriate sites, I.e. along the muscle responsible for this problem, were not treated and/or treated with an insufficient concentration or amount of Botox. Additionally, a small amount of a low viscosity, malleable, cohesive HA filler may be used under the line, which can act as a buttressing support when the muscle below is active. You would be wise to make sure to consult with an experienced, board certified cosmetic dermatologist filler expert. Hope this helps and best of luck.