Developing these lines when I smile. What causes these lines? What can be done to make them go away? (photos)

Question

I started developing these lines when I smile. It makes me self conscious because they're very dramatic. What can be done to make them go away? When I pull back on the skin while smiling they disappear.

Jason Emer, MD · Answer

A combination approach would give the most improvement. Deep wrinkles and smile lines can be improved with a combination of Botox and/or fillers for the lines themselves and to build anatomical support with Sculptra for collagen building. Ultherapy is a great skin tightening device, but works best in combination with other treatments like J Plasma, RF treatments, lasers, microneedling/PRP, salt facials, Cosmelan for skin tightening and improve skin tone. I recommend getting a formal evaluation with an expert. Best, Dr. Emer

Nima Shemirani, MD · Answer

Hi @akw33! I recommend Morpheus 8. Morpheus8 is a non-surgical treatment for full body skin resurfacing, skin tightening, and fat reduction of stubborn areas. It uses minimally invasive fractional radiofrequency energy (RF) to penetrate the skin deeper than other microneedling devices, triggering the skin’s natural healing response to promote skin tightening and lifting.

Jonathan Kulbersh, MD · Answer

Thank you for your question and photo. You may benefit from a combination of injectable formulas to treat the parallel lines you’re referring to. Hyaluronic acid dermal fillers can be administered to add volume to this area and diminish the appearance of the lines. A collagen stimulator known as Sculptra can also be used to stimulate the body’s collagen production, restore lost volume, and improve skin laxity. I recommend scheduling an in-person consultation with an experienced, board-certified injector. They will be able to examine your concerns and suggest the best course of action to help you achieve your aesthetic goals.

Michael A. Persky, MD · Answer

Hi Akw,
You are not alone, this is a common complaint.  It occurs because of loss of volume, loss of elasticity of the skin, and facial movements.  Loss of volume and elasticity can be addressed, we want to keep your facial movements.  I would treat you with a combination of treatments for maximum results.  I would use a foundation of Sculptra under muscle and over bone, combined with Profound RF (microneedle radiofrequency) with PRP (Platelet Rich Plasma).  In addition you would likely benefit from additional filler at the angle of your jaw and along your jawline.  If you are ready to undergo surgery, then a deep plane facelift should help as your problem disappears when you pull back your skin.  Please feel free to call our office to schedule an in person or virtual consultation.  Good luck and be well.  Happy Holidays!

Michael Persky, MD
Encino, CA 
818 501-FACE

Harold J. Kaplan, MD · Answer

Hello AKW.  For the most part, the lines you are seeing have to do with the natural aging process and your particular anatomy.  As we age, we lose volume when fat and collagen diminish in the facial skin.  One way to counteract this loss is to use a product called Sculptra (see link) as it develops your own collagen, giving you back much of what you have lost.  It is a very natural looking "filler" as it is your own tissue that is making up the volume.

Nelson Lee Novick, MD · Answer

The condition described and seen in the photo is actually quite common and has a family trait tendency at its basis in many cases. These lines typically worsen with smiling and are located parallel to the mouth and are most prominent with smiling, hence their name "parallel laugh lines."  With time, these dynamic (i.e. motion-related) lines can leave the skin etched with by crinkles and fine lines ("static wrinkles") if left untreated. I have found the use of a cohesive, low viscosity HA filler injected by a fanning approach below and 90 degrees to these lines to be a very effective way of treating them. You would be wise to consult with an experienced, board certified cosmetic dermatologist filler injector. Hope this helps and best of luck.