Mouth Lines and Treatment - is CO2 the best option? (Photo)

Unfortunately, the spots are areas of hypopigmentation, which cannot be corrected with topical treatments or standard procedures. However, a deep laser resurfacing treatment may help create a more uniform appearance by lightening the overall lip color

Fractional CO2 laser is an excellent tool for skin rejuvenation in our center in Santa Monica. We use the fractional multi-depth ablative approach to help resurface the skin, recontour acne scars, improve incisional plastic surgery scars, and reduce surface irregularities from skin tone to dark pigmentation. Our approach utilizes a multi-depth approach that targets melanocytes in the epidermis and collagen fibroblasts in the dermis. This approach can be combined with a TCA Peel in a process known as a sapphire peel. Fractional laser is excellent for acne scars and contour scars in the skin. Patients are advised to undergo skin protocols with Melarase creams before and after treatment to help reduce pigmentation. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. After the laser, we expect redness for a few weeks as the skin improves. PRP and Hydrafacial enzyme facials can further improve skin quality after fractional co2.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. Yes, while CO2 laser resurfacing can be one of the most effective treatments for deep or persistent mouth lines, repeated or overly aggressive sessions—especially over many years—can sometimes lead to issues like pigment changes, tiny white bumps (milia), prolonged redness, or even gradual thinning of the skin and loss of elasticity. At age 60, and with a history of multiple resurfacing and microneedling treatments, your skin may be showing signs of cumulative damage rather than continued collagen stimulation. It’s wise to take a more conservative approach now, focusing on maintaining skin health rather than continued resurfacing. Fractional, lower-energy CO2 treatments may be safer options for maintaining texture and tone without further compromising elasticity. Supporting treatments such as platelet-rich plasma (PRP), radiofrequency microneedling, and medical-grade topicals (retinoids, peptides, antioxidants) can help rebuild collagen more gently. I hope this helps!

At this stage, before considering any more aggressive treatments, such as the CO2 laser, you may wish to explore the use of a low viscosity, malleable, cohesive HA filler properly injected to help smooth this region. This can be accompanied by a few microdroplets of Botox placed appropriately along the region of the upper lip vermilion to diminish the muscular action there responsible in large measure for the formation of these vertical, "lipstick bleeding" lines. A series of superficial peels, using high concentrations of glycolic or salicylic acid, Jesner's Solution, or low concentrations of TCA may provide addition improvement in the overall texture of the skin. The results of the filler treatment are typically immediate and those of the Botox usually manifest a few days later. You would be wise to consult with an experienced, board certified cosmetic dermatologist. Hope this helps and best of luck.