Filler vs skin treatment for vertical wrinkles near mouth? (Photos)

Question

Hello, I have very slight vertical wrinkles that appear near the sides of my mouth when I smile. Do you think I’m a good candidate for filler using the fern technique directly into the slight wrinkles or should I more so go the skin rejuvenation route and get micro needling or co2 laser for this?

Nelson Lee Novick, MD · Answer

From the photo provided the areas pointed out by the arrows within the lower cheek walls when you are smiling appear to be an early stage of what have come to be known as "parallel laugh lines". These are not the same as smile lines that radiate down from the sides of the nose nor are they Marionette lines that form at the angles of the mouth and slant downward.  
For Parallel laugh lines, I have found that the use of a low viscosity, malleable, cohesive HA filler fanned appropriately beneath and perpendicular to the folds can produce quite a satisfactory support to the regions and to significantly diminish the appearance of these folds with smiling. You would be wise to consult with an experienced, board certified cosmetic dermatologist injection expert and best of luck

Anna Chacon, MD, FAAD · Answer

Hi,

Thank you for sharing your photos and describing your concerns. The slight vertical lines near the mouth—sometimes called “smoker’s lines” or perioral wrinkles—are very common, even in people with otherwise smooth skin.

For very fine lines like yours, you have a couple of safe and effective approaches:

Filler (Fern Technique):
This technique places tiny, precise amounts of filler directly into the fine wrinkles to smooth them.
It can give immediate improvement and is especially helpful if the lines appear more when you move your lips.
The key is subtlety—overfilling can create stiffness or an unnatural look.
Skin Rejuvenation (Microneedling, CO2 Laser, or Fractional Lasers):
These treatments stimulate collagen production and improve skin texture over time.
They are particularly effective for very superficial lines, skin quality, and overall smoothness.
Results are gradual but long-lasting, and they also improve surrounding skin.

Sometimes the best results come from combining approaches: gentle filler for dynamic lines and a skin-rejuvenating treatment to strengthen the skin and prevent deeper lines from forming.

Given that your wrinkles are very slight, either option could work, but skin treatments alone might give a natural, soft improvement without adding volume—especially if you’re cautious about maintaining subtle movement around the mouth.

The main goal is enhancing what you already have while keeping expressions natural, and starting gently usually gives the most satisfying results.

Filler vs skin treatment for vertical wrinkles near mouth? (Photos)

Answers (2)

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