After Three Laser Facials, Still See Fine Lines Around my Mouth

Lip lines "smoker's lines" can be reduced with laser resurfacing, or with augmentation of lip volume.
Depending on the type of "laser facial" you received, you may be at the limit of what can safely be done with resurfacing techniques without causing whiteness or an abnormal shiny appearance due to dermal architecture destruction.
Lip augmentation with temporary hyaluronic acid filler or more permanently with fat injection or LiveFill (nontraumatized fascial fat grafts) are an option as well.

Lines around the mouth are called "Smoker's lines" in many parts of the country, but in Utah where we have the lowest incidence of smoking in the nation, we call them "Whistle lines".  These lines form in response to repeated contraction of the circular muscle surrounding the mouth called the orbicularis oris.  These lines can be very difficult to treat, especially when deep.  A superficial laser, the kind you probably received, is just not aggressive enough to rid yourself of these lines.  Usually you will need one, two or even three different approaches.  The first is a resurfacing treatment.  This needs to be aggressive and deep.  Options include:


Deep Erbium:YAG laser, not the superficial or even the fractionated kind, but the real deal

Dermabrasion

Deep chemical peel like a Baker's (Phenol mixed with Crotton oil and water) peel


If that doesn't do it.  Then you fill the volume deficiency.  Options include a Facelift with SMAS harvest and implantation of SMAS into the lips (not really an option for a 33 year old), Restylane or Surgisil soft silicone lip implants.  Sometimes this would include a second resurfacing treatment.  Botox is rarely an option as the results are unpredictable and with mouth motion can make you look like you've had a stroke, so be careful.  Obviously, the more aggressive the treatment, the more adverse effects you can have and the longer recovery.  So, have a long discussion about expectations with your surgeon. 

​Fillers such as Restylane Silk, Belotero, or Juvederm can work well to treat lines around the mouth, but the best first option is laser resurfacing or deep peels to induce collagen production. Superficial radiofrequency devices and microneedling can help as well and are less invasive. I suggest going to an experienced cosmetic dermatologist with expertise in lasers and fillers. Best, Dr. Emer​

Lines around the mouth are a common concern for which I see patients in my clinic in Pensacola, Florida.  They are certainly able to be improved with laser resurfacing but it often takes a fairly deep resurfacing of this area which may require an extended downtime.  If you do not have the downtime available (approximately 2 weeks), you will benefit from a series of peels of less depth to achieve improvement of the lines.

I do not like to use neurotoxins such as Botox, Dysport or Xeomin to treat lip lines but I have been able to achieve significant improvement with Belotero, one of the latest hyaluronic acid fillers which is able to be placed very superficial in the skin.

Best Regards,

Jacque P. LeBeau, MD

LeBeau Clinic Facial Plastic & Reconstructive Surgery

These lines are incredibly common in Denver (sun exposure, dry air) among both smokers and non-smokers. They are very difficult to treat! Deep laser resurfacing is effective as are Botox and dermal filler treatments. In many cases comprehensive treatment using all three options are required. Stephen Weber MD, FACS

Many, but Not all lines and wrinkles can be removed with laser.  Skin laxity and volume must also be addressed. A good laser resurfacing procedure that is appropriate for you can take off many wrinkles.    Some lifting and or volume restoration of the skin may also be necessary.

Wrinkles are a property of the dermis.  Any type of peel that you would be doing as a series is almost certainly not getting into your dermis at all.  A peel such as that is taking off the top part of the epidermis, which grows back, then you peel it again, it grows back, and so on.  As you can see, the only thing this type of peel affects is the epidermis over and over, but the wrinkle is in the dermis.

You need a single aggressive peel to address wrinkles.  At age 33, you could consider a fractionated deep peel such as Matrix, DOT, Fraxel Repair or others that use a CO2 laser and go well into the dermis.  While this isn't as effective as a regular deep peel, the healing will be far less and 33 year old wrinkles should respond nicely.  The non-ablative treatments such as Fraxel do even less than a superficial peel in that they usually affect neither complexion or wrinkles.

Laser Peels or Laser Facials are a superficial laser treatment that is intended to build collagen slowly. The best use of laser facials is for maintenance or for subtle improvement.  To correct the lip lines, you may need a more intense laser treatment such as laser resurfacing or profractional.

With resurfacing it takes time for the collagen to repair and help decrease more wrinkles or so most people say. In my experience, the results that you get the first month is likely the most noticeable and after that the results are more subtle with the "naked eye". When done on a more aggressive scale, you will notice more improvement more early on such as a month or two. 12 months is a little long in my opinion to notice much more difference. In terms of the lip lines, you might want to approach it more aggressively with the laser. Dermabrasion can also work wonders here.
In addition, you may want to consider plumping up your lips. A lot of the lip lines are created due to a loss of volume in the lips and the area around your mouth. Fat injections and fillers are great at creating this volume in the long and short term respectively.
Consulting a Board Certified Facial Plastic Surgeon would be something that I would recommend. We specialize in the face and are highly qualified to help you with this.

 
The fact that you had 3 laser peels means that they were very superficial peels and not likely strong enough to remove mouth lines.
Newer Combined laser resurfacing which uses both a non-ablative fractional 1540 Erbium and an ablative 2940 fractional Erbium at the same time, provides the deepest and most effective improvement in lines around the lips and cheeks.
Even with excellent laser resurfacing results around the mouth, wrinkles persist. This is because the pursing muscles of the mouth cause wrinkles. For best results small amounts of Botox can lessen these dynamic lines. Filler injections can plump the lips and help the lines.
Thus, the best treatment for lip lines is a combination of combined laser resurfacing, Botox and Fillers.