I use Tretinoin, SPF, skincare and tried Sculptra. Best treatment for smile line creases? (Photos)

A: Hello! I’m Lauren, the aesthetic provider here at Colorado Plastic Surgery Center. You're already doing a lot of the right things; using tretinoin, SPF, and even adding Sculptra to support collagen. Those are all solid steps for long-term skin health and wrinkle prevention. As for that smile line that’s starting to settle in, there are a few good next options to consider: CO2 laser and microneedling can stimulate collagen and help improve fine lines and early wrinkles. CO2 is more aggressive and tends to deliver more dramatic results in fewer sessions. Microneedling is gentler and often done in a series, especially when paired with PRP, which can boost the regenerative effect. If the wrinkle is shallow to moderate, either treatment could help smooth the area and improve texture, especially since you're already supporting collagen with Sculptra. Filler might be a better choice if the wrinkle is deeper and needs more immediate softening.

A consult with a skilled injector or laser provider who can evaluate the depth and location of the wrinkle and help tailor the best approach, whether that’s collagen stimulation, filler, or a combo.

I think you first have to be realistic that as you age, it is very unlikely / probably impossible that you will have absolutely no wrinkles on your face. We age. It happens. To MINIMIZE this as much as possible, it sounds as you are already doing what you should -- good skincare and considering collagen boosting treatments like sculptra. I would continue to maintain these and/or consider more aggressive skin procedures like possibly laser.

It’s great that you’re already using tretinoin and SPF, as those are key foundations for maintaining healthy, youthful skin. Smile lines, or nasolabial folds, tend to deepen over time due to natural volume loss, repetitive facial movements, and changes in skin elasticity.

Since you’ve already had Sculptra in the cheeks, that’s a smart step—it helps lift and support the midface, which can soften the appearance of smile lines indirectly over time as collagen builds. However, if you’re still noticing a visible crease, there are a few next options to consider:

Targeted filler placement directly in the nasolabial folds can provide more immediate improvement.

EZ Gel (platelet-rich fibrin gel) is another great option—it uses your own platelets to naturally rejuvenate and add subtle volume while stimulating collagen production.

Skin boosters or microneedling with PRP can also help improve skin texture and elasticity around the area.

I’d be cautious about placing Sculptra directly into the folds, as it’s generally best used in broader areas for collagen stimulation rather than fine lines. Combining subtle filler support with collagen-stimulating treatments often gives the most natural, long-lasting result.

One of the problems with Sculptra (and one of the reasons I stopped using it many years ago) is that it generally takes about three sessions to achieve optimal results.
For the very early smile line seen in the photo, I would simply use a malleable HA filler injected relatively superfiially below the line. In experienced hands, this should yield an immediate result and the treatment should take no more than about one minute (literally) to perform. You would be wise to make sure to consult with an experienced, board certified cosmetic dermatologist filler injection expert.
Hope this helps and best of luck.

A great skin care routine is always recommended. To address skin tone and texture you can look into SkinPen or Morpheus8. These treatments use microneedling and microneedling plus RF technology to improve skin tone and texture. I've included a video I hope you find helpful.