I had CO2 ablative laser around my mouth and Chin 2 times in one year, why isn't it working? (Photos)

Question

I'd like other doctors opinion: Why do I still have wrinkles? The Dr. admitted it didn't work the 1st time it looked the same. So the 2nd treatment was free. He says it still needs a third treatment. Why doesn't it work? Anyone experience this?

Jason Emer, MD · Answer

you will not clear this just with laser alone you need an early face or neck lift, and fillers. between co2 laser you should be doing plasma pen and/or fraxel or halo regularly.  start dermarolling at home. you will need many treatments. Best, Dr. Emer.

Nelson Lee Novick, MD · Answer

I'm really sorry that you have gone through ablative lasering twice without much benefit. But, if what I see is pretty much what you had BEFORE the laser treatments, then I would have been inclined to recommend treatment with fillers. Less robust fillers, such as Belotero Balance, would handle the vertical lipstick bleeding lines that are particularly pronounced above your top lip, as well as the crepeyness to the sides of the mouth and chin. Restylane Lyft would help to straighten the downturned marionette lines and would elevate and smooth the relatively deep mental crease (the fold between the bottom lip and the chin. The results of this kind of treatment typically engender an immediate "Wow!" reaction and little to no significant downtime. It is difficult to say why you haven't responded to the laser treatments. It could relate to provider lack of expertise or experience, but more likely in my opinion going the laser route, rather than the filler route. Hope this helps and best of luck.

Sheryl D. Clark, MD, FAAD · Answer

Dear RSmember:

It’s all about understanding what you are treating and the doctor and patient being on the same page. In your photos at least, I see multiple issues which would require different modalities of treatment, depending upon what you were trying to improve. CO2 is excellent for fine lines and sun damage and brown spots as well as scars, but it cannot tighten or lift the skin, get rid of deep upper lip lines, nor increase volume that has been lost. If you can have a frank discussion with your doctor, trying to understand exactly what it is you were trying to improve, you may be able to have a different modality of treatment to address your issue or issues.

You should be careful about repeating CO2 in the same area, because if the skin is not fully healed under the surface, you can get much more ablation and downtime. It may be better to wait at least three months before having another CO2. Having said that if it’s the upper lip lines that you were trying to improve, I have found that two sessions with Ultherapy works much better than CO2. Also, if they are due to an overactive muscle around the mouth, relaxing a portion of that muscle with a tiny bit of Botox near the lip line can really help a lot. Lastly, a little bit of filler to the lips would actually help to soften the lip lines that approach the pink portion of the lip itself.

If you were concerned about what you see going on at the corners of the mouth and on the chin, I do believe that fillers would help your problems a lot. I believe I also see dimpling of the chin, with attachments of the underlined the mentalis muscle to the skin of the chin, which could be relaxed with a tiny bit of Botox to that muscle.

If you are concerned about some skin laxity that is adding to the droop of the corner of the mouth and a tiny bit of jowling, a full face microneedling with radiofrequency could be very helpful, for example, with Secret RF/Fraxis Duo.

I hope this helps!

Sheryl Clark MD FAAD

Anshul Gambhir, MD · Answer

Thank you for your question. It is hard to determine why the laser did not work. There are many different depths that the laser can penetrate too and the deeper the depth the better at removing deep wrinkles. Typically the deeper depth has about a 2-3 week recovery period and then it does take several months to start building collagen which will smooth and soften the lines out even more. Hope this helps!

Anthony Farole, DMD · Answer

Assuming the CO2 laser was done traditionally and inclusive enough and with the appropriate energies a third laser is unlikely to make much of a difference. It appears you have lost some volume around the mouth, nasolabial area and drool troughs. Fillers will help restore volume and help “unwrinkle” the areas of your concern. In addition RF MICRONEEDLING will tighten the skin, restore some collagen and reduce crepe skin. Long term a mid face and neck lift will definitely provide nice results.

Milan Doshi, MS, MCh · Answer

Hello pat duran, Thank you for your question and photographs. For the best-personalized advice photographic evaluation is not enough. An in-person consultation is a must.
The concern which you are worried about is smokers line in the perioral area. The procedure which you have already undergone is Fraxel laser but with not very satisfactory results. You can do skin booster fillers for this area or Mesobotox around the upper lip area by a board-certified dermatologist, who is an expert in the procedure.
Please consult with your dermatologist or a board-certified dermatologist near you and discuss in detail. Best of luck, Dr Shweta Mumbai, India

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