I have wrinkles above my upper lip. I've tried Botox but it isn't working. Is there another solution?

Question

My upper lip has deep wrinkles. I've never smoked and it's so unattractive. Generally I get Botox for 11 lines and filler as needed but Botox is not working at all on the upper lip.

Nelson Lee Novick, MD · Answer

Repeated, daily motion of the muscles around the mouth with time eventually can lead to deep vertical creases around the mouth--much like a crease line forms in a blank sheet of paper after it is formed. And just as simply stopping the folding of the paper will not erase the crease previously created by folding, Botox, which works on quieting muscular movement, will simply slow the process, but generally has little effect of creases that are now present at rest. To effectively treat deeper "bar code" lines around the mouth, BOTH Botox to diminish the relentless muscular creasing (the dynamic component) AND filler to treat the creases that have already been created (the static component) are generally required. So, it would seem that filler would be the next step.  Just be sure to consult with an experienced, board certified dermatologist. Hope this helps.

Anna Petropoulos, MD, FRCS · Answer

Hello chi910, thank you for your question! These upper lip wrinkles are so common and can be extremely stubborn. Using botox or another neuromodulator to restrict the movement causing the lines is an important first step, but if the lines are deep there will be more pieces to the puzzle.

In our office, step 2 alongside botox is to treat the skin itself. This would be through high-quality skincare (we like Defenage), microneedling or RF-microneedling (such as SylfirmX, Morpheus, Scarlet), and other resurfacing modalities such as Plasmage and Clear & Brilliant to tighten & rejuvenate the skin and allow for new collagen growth in those grooves.

Lastly, filler can be a wonderful addition to the treatment plan, if both product and patient are selected carefully. For deep lines resistant to or still lingering after other treatments, a filler with a little bit of structure like Versa or Juvederm Ultra can make a nice difference. For super fine lines, SkinVive injectable hydrator helps to plump the skin without adding additional volume, thus smoothing out the skin in those areas.

I hope this helps, best of luck in your search!

Best,
Genie Alexander, RN BSN for Dr. Anna Petropoulos, MD FRCS at Center for Classic Beauty, Danvers & Boston, MA.

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

Jonathan Kulbersh, MD · Answer

Thank you for posting your question. Dermal fillers may be a great solution for lip lines and wrinkles that can also be used in combination with Botox for more dramatic results. Volbella is a Juvederm filler that adds volume and smooths out lines and wrinkles around the lips caused by aging, smoking, or sun damage. Laser resurfacing or RF microneedling are also options for treating this area. It is always best to seek an in-person consultation with a board-certified facial plastic surgeon that can provide detailed guidance and treatment options customized for your needs.

Kian Karimi, MD, FACS · Answer

Fine lines in the perioral area are a very common concern for a lot of patients. Some of these lines are indentations in the skin which can be addressed with fillers. I’d recommend switching up from botox to dysport with a combination of fine fillers to soften up those lines. Nonetheless, I would recommend you to complete multiple in office consultations with board certified facial plastic surgeons to discuss your ideal outcome. This way, they can assess your face in person and determine the best treatment for you. Best of luck! Kian Karimi MD, FACS

William C. Harris, MD · Answer

Hi,
Botox in small doses to upper lip can help reduce fine wrinkles, but for deeper wrinkles in the peri-oral area there are more effective treatments. The two I would recommend are laser resurfacing (CO2 or Erbium) and chemical peel. The laser resurfacing varies with recovery time from about 1-4 weeks depending on type used, settings, and the individual. A deep chemical peel is very effective for deep wrinkles and skin resurfacing as well, but comes with a 4-6 week recovery time and because of this is a treatment many patients choose not to pursue. There are risks with both, but finding an experienced provider who offers these would be my recommendation.

Vibha Gambhir, MD · Answer

Hi Chi910,

If botox is not working for above the upper lip I would recommend filler. The filler that would be used is Volbella. Volbella is a very thin/fine filler and last up to a year.

Sincerely,
Gambhir Cosmetics

Dean P. Kane, MD, FACS · Answer

Dear chi910, 
Between the nostril sill and the interlabial space are different areas of the upper lip. Options include the depth and cause of the wrinkle. With aging, we lose collagen strength maintaining the skin and fat structure. Under the fat are the ring and radiating muscles controlling lip motion. Generally, thinning skin, loss of fat and thickening muscles will create a pull on the skin causing a wrinkle. Single and combination treatments include:
•	Topical retinoids to stimulate skin collagen formation
•	Injectable Sculptra to stimulate fibro-fatty firming and skin firming with collagen and other structural molecule formation
•	“botox” or other injectable muscle relaxers to weaken those muscle fibers creating a accordion-action creasing the lip; either radially or transversely.
•	Fillers to expand the skin or fat to fill the crease
•	Chemical peels and radio-frequency / laser to stimulate a collagen firming and tightening of the skin
•	Intradermal PDO and PLLA threads to provide structural support and stimulate collagen formation in and under the skin. 
•	Surgical undermining and lifting or grafting the upper lip
•	Consult with a experienced, knowledgeable, skilled, artistic, Board Certified Plastic Surgeon or other injector who fully understands the aesthetics, anatomy and panoply of options and how to use them. 
Lots to consider. All the best!

Camille Cash, MD · Answer

There are various treatments for the upper lip lines.  Depending on the situation you may benefit from a thinner filler.  Sometimes lasers are indicated for resurfacing.  I encourage you to begin by visiting with a expert injector to determine what is recommended for you.

Joseph Batac, MD · Answer

Good day and thank you for your question. If you could prove a photo that would be helpful. My questions would be if the lines you are referring to are around the mouth or if they are in the actual lip itself. If they are around the mouth some fillers are helpful with that. Good luck with the rest of your journey.
Cheers,Joseph Batac, M.D.Double Board Certified Plastic surgeon

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