Best solution for crepey skin texture around smile lines on a 30 year old? (photos)

Question

Im concerned about worsening skin texture around my smile lines. I have acne-prone skin w/scarring (probably part of the issue) now the skin is getting loose, uneven and crepey.When I smile it collects into 2 parallel smile lines. It got worse after I started using retinol & while it improves a bit when the skin is well-moisturized, this is temporary. I don’t know if the issue is texture, scarring, wrinkling, or a combination? Should I consider peels, microneedling or laser resurfacing?

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best,
Dr. Karamanoukian 
Realself100 Surgeon

Danielle Shanley, MD · Answer

A combination treatment approach would be best for your concerns. Dermal fillers will help restore lost volume and revitalize skin immediately. In conjunction with the filler, the Profound laser treatment would tighten the skin for a longer period of time. Profound is a revolutionary new energy-based facial treatment designed to create new elastin, collagen and hyaluronic acid – the building blocks that keep your skin smooth and elastic. It is a microneedling and radiofrequency treatment that tightens and lifts the skin, especially in the lower face.

Jason Emer, MD · Answer

I recommend fillers to soften the lines themselves and also lift around the mouth and cheeks to build underlying anatomical support. In our practice we combine Sculptra with other fillers "layered" on top as well as lasers, skin tightening treatments (Thermage, Fractora, Renuvion), thread lifting,  and peels to get the most conservative, natural look. I suggest seeing a facial sculpting expert for a formal consultation. Best, Dr. Emer

Edwin Cortez, MD, FACS · Answer

I think you have done well in analyzing your problems.  You have obviously dehydrated this area with the retinoid which makes these lines appear more prominent.  I would encourage you to decrease and/or change your retinoid to improve hydration.  I would consider adding a good hydrator to the affected areas. A hyaluronic acid filler properly injected should markedly improve the depths of your lines.

Charles M. Boyd, MD · Answer

Thank you for your question. Although I recommend seeing a board certified plastic surgeon to better assess your skin, a combination of CO2 fraxel laser and fillers can improve skin texture, lines, and scarring. Medical grade skin care consisting of a retinol, vitamin c serum, and sunscreen can also improve scarring, pigment irregularities, and fine lines over time. Best of luck.

Katherine Dee, MD · Answer

Three recommendations: 1. RF microneedling with Genius (used to be called Infini) to correct scarring and thicken skin and decrease wrinkles, 2. Restylane Defyne to soften the lines themselves and 3. Medical grade skin care including an exfoliating cleanser with glycolic acid (or glycolic and salicylic) Vit C, HSA and/or retinol serums, moisturizer and daily sun block.

Kamran Dastoury, MD · Answer

it looks like your problem is some excess skin due to either volume loss or skin laxity .
 Common solutions for that area would be to add volume with nonsurgical options such as I Ronek acid fillers or something more permanent like that transfer 
For the skin laxity I would recommend play to resurfacing with Co2 or radiofrequency MIcro needling.

At Modern Surgical arts we usually recommend a combination of the above for the best results,  hope that helps.
Dr Kamran Dastoury, MD

Shaun Patel, MD · Answer

I think a combination of filler, lasers, and skincare should get you a nice result. I would Restylane Refyne for the laugh lines. I would use Ematrix or fractionated CO2 to improve the quality of the skin by stimulating collagen production. Finally, I would use antioxidants, sunscreen, retinol and moisturizers to to continue improving the quality of the skin between treatments. Retinol should not have worsened the lines although it may have dried your skin initially.

Victoria A. Cirillo-Hyland, MD · Answer

After looking at your photos, I would recommend a filler like Restylane Refyne and/or Fractionated microneedling with radiofrequency, like Infini.  Keep up with your good skin care regimen as well...sunscreen and retinol.

Best solution for crepey skin texture around smile lines on a 30 year old? (photos)

Answers (9)

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