Laser / Radiesse Treatment for Dynamic Lines Around Mouth?

I'm going in for a consult with a facial plastic surgeon regarding the harsh dynamic lines that have developed on both sides of my mouth when I smile. I would like opinions on CO2 resurfacing vs Radiesse or both before going in. On the left side is a small static line that has been there since HS because I used to sleep with Clearasil all over, but it has gotten deeper and is now causing a 2nd comma line behind it. There are no other static lines;I feel the lines add years to my face...

Doctor Answers 6

Treatment for deep lines around the mouth

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Before deciding what is the best treatment for lines around the mouth, what is needed is a global assessment of the soft tissues of the face.  The paradigm of treating the symptom (that is, the lines around the mouth) is being replaced by diagnosing and addressing the problem.  The problem may be an overall loss of soft tissue in the upper face.

Starting with age 30, we lose approximately 5 cc of facial soft tissue every year.  It is primarily lost from the upper face: temples, brows, upper cheeks.  And it's not only soft tissue, it's sometimes bone as well.  This soft tissue and bone in the upper face is what supports the facial structure.  As this tissue is lost, the other tissue, like the lower cheeks descend, sort of like a deflating balloon, contributing to an accentuation of the nasolabial fold and formation of other lines in the lower face and around the mouth. 

Soft tissue of the upper lip is also lost, resulting in a thinner upper lip and an additional deepening of the nasolabial fold.

We have to consider all these soft tissue compartments before making a decision on how to treat the wrinkles.  It may be that by filling the temples and upper cheek compartments, the lines of the lower face will flatten out.

Radiesse is great for the deeper folds like the nasolabial fold, but not great for superficial wrinkles or ones that are in highly dynamic, mobile areas.  Those are better addressed with hyaluronic acid fillers.

I recommend talking to your plastic surgeon about the overall assessment of your face and evaluation of the soft tissue compartments before making a decision as to what to do. With you looking in the mirror, your doctor should examine your face to see if and where there is a decrease or loss of soft tissue on the face.

Please take a look at an article from Science Daily: Facial Aging is More Than Skin Deep.  It will give you a pretty good idea of addressing wrinkles from a global rather than a local perspective.

Short Hills Dermatologic Surgeon

Laser / Radiesse Treatment for Dynamic Lines Around Mouth

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You appear very young and please consider ALL the risks. Fillers are easier to correct vs ablative lasers. Seek in person opinions MANY before considering an invasive action. From MIAMI Dr. Darryl J. Blinski, 305 598 0091

Don't fix it if it isn't broken!

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From the photograph you provided, you appear quite young! You don't appear to have much in the way of sun damage or strong lines, either. When we look at a face, we divide a patent's concerns into dynamic and static features. Treating lines that are visible at rest (static) is much more likely to make doctor and patient happy. I warn patients about "chasing" lines that are only visible in activity (dynamic). These treatments almost always result in outcomes that wont make us happy. Filling a line that is only visible in activity may leave a bulge when it is at rest. Fillers for the liens that go from nose to mouth corner (nasolabial folds) is a very pleasing procedure for most people. If you have never done fillers before, please start with a temporary filler like Restylane or Juvederm. Radiesse is a long-term filler and can be unforgiving, if you are not ready for it. Laser resurfacing encompasses several different techniques. The only one I would consider for you would be fractional CO2 resurfacing. It is very safe and has an easy recovery time. You may want to consider TCA (trichloroacetic acid) peeling, a very effective and customizable approach.

Barry Resnik, MD
Miami Dermatologist

Dynamic smile lines defy a long-term result

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The dynamic smile lines to which you refer are difficult problems to treat in terms of getting a good long-term result. They are a natural result of those who have a wide smile (which is actually a well received expression) and skin that is thinner. Because they are dynamic, there is not a good way to stop them from forming. For certain, there are two potential treatments that I wouldn't do, botox or laser resurfacing. They will not be effective. The only good treatment would be injectable fillers as they will reduce their depth. But they will only be temporary and the ongoing smiling motion will work to decrease how long they will last.

Paraconcentric smile folds

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Please be very careful not to rush into any treatment! These dynamic lines are related to the muscle pulling on the skin. If Botox were used, it would interfere with your speech and eating and you would look unnatural as if you had a stroke. Fillers used to make it look good with motion, might make the skin look lumpy or too full at rest if they are injected under those paraconcentric smile folds.  Generlized cheek volume may help. Also if there were any recent dental work / appliances, this might affect your perioral shape temporarily. Lasers and Thermage tightening may not provide you with any improvment since this is a volume and muscle movement issue.  Be sure to consult with a physician who has a lot of experience in treatment of facial rejuvenation.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Facial lines and options

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Deep facial lines like those around the nasolabial crease can be sometimes treated with facial fillers. Radiesse is one option but another is a hyaluronic acid like perlane or juvederm. As for ablatve lasers like CO2 it would be hard to say without an exam.  Facelifts also help with early jowling and nasolabial thickening.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.