What is the Best Method to PREVENT the Worsening of Perioral Lines (I.e. Vertical Lip Lines, Smokers Lines)?

Question

I'm 31 and, in general, my skin is still very youthful. But after years of smoking/indoor tanning, I'm noticing volume loss above my lips and the formation of two small lines in the perioral region. Right now the lines are barely noticeable but I know they will only get worse. I'm considering tiny amounts of botox to relax my lip muscles, and profractional laser resurfacing to reduce my lines and increase collagen. Is laser resurfacing every several months a good course of action for me?

David R. Stephens, MD · Answer

At 31 you are noticing early changes in your skin and that reflect the development of some new lip lines. This is early for most women and disconcerting.You nailed the likely culprits, namely smoking and UV radiation. There are probably other genetic and racial factors too, such as the predisposition of northern Europeans to have thinner skin as well as the role of the upper jaw and teeth in supporting the upper lip. This could have a role in your noticing that your lips are thinning out. It has been pointed out to me by experienced aestheticians, that men don't have perioral lines because they shave. Interestingly, I don't see these on men to the degree that they are found in women. That said, I have a Sciton Laser with fractionated and resurfacing systems. I have done deep resurfacing for deep lipstick lines with very good results averaging roughly 50% improvement per treatment. Like dermabrasion used previously, erbium Laser resurfacing seems to work better than CO 2 devices for this. I also place small amounts of Botox in the superficial lip which helps but may cause some difficulty with preventing dripping water through the lip. Interestingly, I have seen this help to plump the lip, although it is not a filler. I think fractionated Laser is a good adjunct but resurfacing is the key. Diluted Juviderm also seems to work well for fine lines but very little is used and this may not last more than a few months. Frequent light Laser resurfacing with small doses of Botox are a good way to treat a few lines with minimal down time; you should do both due to the preventative effect of both. Deeper resurfacing will yield more dramatic improvement, but with more downtime. Find an experienced board certified plastic surgeon or dermatologist with this device. I think that it is a great Laser for this application. Also, you need to stop tanning your face, (and everywhere else, I know it makes you look healthier and sexier right?). Seriously, a sunscreen and Retin A or retinols help improve skin turnover; exfoliating may help too. Consider using a good medical grade skin care line for your face as the lips are probaply an indication to what is happening to your facial skin in general. Good luck!!

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.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. 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

Anthony Bared, MD, FACS · Answer

As far as the prevention of perioral lines the first recommendations are the obvious lifestyle modifications of smoking cessation and sun exposure avoidance. Treatments with small amount of Botox to this area are helpful in softening these lines and preventing the worsening of the lines. You should also start on a topical skin care regimen with tretinoin which helps improve sun damage skin and sunscreen. Additionally, to treat the existing wrinkles, fractionated laser is a great option with minimal downtime.

Benjamin Barankin, MD, FRCPC · Answer

The best way to prevent perioral lines is to have dark skin and be a male (thicker skin) who doesn't enunciate as much with their mouth. Not smoking, protecting from the sun with hat, sunscreen and avoidance are very important too, as is not sipping with straws. Helps to have great genetics too. Otherwise, topical retinol or tretinoin or vitamin C can be helpful, but Botox is a great starting point preventatively, and fillers when things are deeper. Laser resurfacing with ProFractional is also a great treatment and preventative option.

David Goldberg, MD · Answer

A combined effort of injectable fillers and Fraxel laser resurfacing is recommended for markedly decresing perioral wrinkles. Multiple sessions of Fraxel laser resurfacing will lead to optimal results. Botox must be used very carefully around the mouth.

Martie Gidon, MD, FRCPC, FAAD · Answer

Smoking and tanning, indoors and outdoors, accelerate the development of lip lines. Daily sunscreen of SPF 50+ and the use of anti-oxidants and Retin A cream will slow down the development of more lines. A small amount of Botox and filler will also help. You may require laser treatments in the future. Have the rest of your skin examined by a dermatologist to make sure everything is normal.

Steven Wallach, MD · Answer

You nailed it on the head. Smoking and tanning will cause lip lines. Sometimes fillers and/or Botox may help.

Richard Ort, MD · Answer

Small amounts of Botox placed into the lips will reduce excess muscle activity and will help prevent the lines from getting deeper over time. Because very small amounts of Botox are used, the results tend to wear off relatively quickly and the treatment will need to be repeated every 2-3 months for best results. Fillers such as Juvederm or Restylane can also be used to treat lip lines. Laser resurfacing can be helpful but the lines tend to recur after laser resurfacing because they are driven by the muscle movement in the area.

Stephen Weber MD, FACS · Answer

This is an incredibly common problem in Denver due to the dry climate and intense year-round sun exposure. Botox and dermal filler tend to be highly effective. Laser resurfacing can also be very helpful but in many cases needs to be aggressive to achieve results. The best option is prevention of further damage to this skin. This includes avoiding tanning, wearing sunscreen, using Retin-A and moisturizer. It sounds like you're on the right track. I hope this information is helpful.Stephen Weber MD, FACS

Richard Fitzpatrick, MD (in memoriam) · Answer

You are very smart to initiate some corrective measures before the problem worsens. The reason for the appearance of the lines is because of loss of normal collagen and elastic fibers secondary to ultraviolet light (tanning) and oxidant (smoking) damage in an area where muscle activity results in repetitive folding/creasing of the the skin with speech and expression. There are a number of non-ablative lasers such as Fraxel Re:Store that stimulate new collagen formation without peeling the skin and these lasers are intended for a course of multiple treatment sessions and give gradual improvement over a period of 6 – 12 months. Ablative lasers such as Fraxel Re:Pair or Profractional actually vaporize tiny bits of damaged tissue with each treatment so result in more rapid improvement but require some downtime for healing. By keeping the density of treatment low (that’s the percentage of the surface area actually covered by the tiny dots of the laser) the visible healing can be minimized but the number of treatments needed increases. The response to treatment can be significantly boosted by using topical agents that stimulate new collagen : Growth factors ( TNS by SkinMedica ). Retin-A or Retinol, and properly formulated VitC ( SkinMedica or Skinceuticals ). Botox can help by putting those muscles at rest that cause the lines, but that is a tricky thing to do, as low dosages that wear off fast must be used in order to avoid problems with speech, expression and eating/drinking.

What is the Best Method to PREVENT the Worsening of Perioral Lines (I.e. Vertical Lip Lines, Smokers Lines)?

Answers (10)

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