Microneedling, Fraxel or something else for lines above lip? (Photo)

Question

I've got these smallish lines above my upper lip that I hate. I've been told different things about how to get rid of these -- Clear & Brilliant (I've had 3 and see no difference), micro needling (once, see no difference). I've also been told Fraxel by one person and heard from someone else it wouldn't work. I've also been told they're not deep enough for filler. I'd love some advice. Thank you in advance.

Tina B. West, MD · Answer

Fine lines above the upper lip (sometimes referred to as "smoker's lines") are one of the biggest concerns among women seeking cosmetic/anti-aging treatment, and are often a presenting complaint in my practice. These lines are typically NOT caused by smoking, but by the repeated action of the underlying muscle, which is ring-shaped (deep below the skin's surface) around the mouth and may cause skin to pucker during normal activities such talking and eating, and especially drinking out of a water bottle.  Just like we see with frown lines, repeated muscle action eventually results in more permanent lines in the skin around the lips. Botox, Dysport and other neuromodulators can be injected in very small doses around the border of the lip to relax the muscle, but in my experience most women aren't happy with the resulting functional impairment (inability to pucker and drink out of straw, for starters).  In addition, at the very low dosage that is used, the treatment only lasts about 6-8 weeks.  I do see a few patients who like the result and come in regularly for this treatment, but most women aren't up for the side effects or short duration.  You mention Clear + Brilliant laser treatment- this laser which is like a "baby Fraxel" is great for overall skin rejuvenation and prevention/building of collagen in patients in their 20's and 30's and also is a great maintenance procedure post-Fraxel, but it won't go deep enough to touch the wrinkles above the lip.  Even with Fraxel (non-ablative laser) treatment, upper lip lines won't be significantly reduced for the longterm.  The most aggressive carbon dioxide lasers can help smooth upper lip lines, but treatment requires a week of downtime, and the lines will come back with repeated muscle movement.  In my practice, I have had amazing results with Restylane Silk for the treatment of lines around the mouth.  I use this hyaluronic acid (sugar) based filler  in a specific technique that I refer to as lip rejuvenation, differentiating it from lip augmentation:  I inject Restylane Silk through a very fine needle to redefine the lip border, smooth the surface of the lip (which typically develops corrugated lines from volume loss), and to very superficially fill the upper lip lines.  The result is a younger looking lip that looks fresh and untouched.  One caution:  I tell patients to expect 2 days of swelling, then the lips look great for 12-18 months.  Of course, this procedure can be done along with carbon dioxide laser resurfacing for even more benefit (I have all of the lasers listed above in my armementarium), but I rarely come across a patient who can spare a week of downtime. What I can tell you is that when I see patients back in the office after having Restylane Silk lip treatment, the first thing I hear when I walk in the room is "I love my lips!"

Rosy Sandhu, MD · Answer

Hello,
 We often treat upper lip lines being a common issue, although it can be challenging to treat effectively without the correct device. I would suggest 3 Fraxel Dual laser treatments. We can improve laxity and texture while resurfacing and also improving pigmentation. Clear & Brilliant is a great treatment but will not go deep enough for improvement of deeper lines & wrinkling. In addition, I would suggest medical grade skin care and incorporate retinol based products along with antioxidants and SPF use daily.
I would recommend being evaluated for filler after your Fraxel sessions are completed. 
Wish you the best, 
Dr Rosy Sandhu

Georges Kaado, MD · Answer

Hello, they have so many great fillers out there now for small lines above the lips.  It is just finding the right person to do the job.  Also a deep chemical peel might be helpful.

William J. Hall, MD · Answer

Fraxel is a non-ablative laser procedure. Meaning the healing processes is less and there are no open lesions after treatment, Fraxel only treats a percentage of the skin per treatment which helps with healing and downtime, a series of 4 treatments is recommended with Fraxel for at least 45% improvement on the treated area. Fraxel has been around for over 13 years and is still one of the best lasers for skin resurfacing next CO2 or Erbium resurfacing lasers. People love Fraxel because you don’t have to be away from work or your social life longer than 5-7 days as where with any CO2 or Erbium resurfacing lasers your down time will be anywhere from 3-6 weeks because the skin is ablated at 100%. CO2 or Erbium skin ablation is a great way to also treat wrinkles especially around the mouth area you can get anywhere from 60-80% improvement on treated area with 1 treatment.  Microneedling is a great maintenance treatment to help keep fine and wrinkles away also helps to resurface skin without the downtime of a laser. Most people use Microneedling as their maintenance treatment to keep skin smooth, glowing by causing micro injuries in the skin helps your fibroblast cells over react and create new collagen. Microneedling can also correct texture like acne scaring, fine lines and wrinkles; it will take more treatments of Microneedling to reach the results of a Fraxel treatment or CO2 and Erbium lasers.

David Shafer, MD, FACS · Answer

One of our favorite treatments to work on with patients is to combine lasers, peels, microneedling, Ulthera and injectables.A popular combination for peri-oral wrinkles is Ulthera, TCA peel or CO2 fractional resurfacing.  If you are a good candidate, even adding light hyaluronic acid injections may help.   Sometimes with other laser or peel modalities, more than one treatment is necessary.  Certainly, microneedling, Clear & Brilliant, Sublative Fractional RF (fraxel) or even Pico Way Resolve there may be a need for multiple treatments.Make sure to do your homework regarding finding a board certified plastic surgeon or dermatologist with great reviews and maybe even a personal reference.Hope this helps.  Good luck.

Christine Gosch, MD · Answer

Correction of the vertical lines around your mouth usually requires a combination of treatments. Microneedling will help but is usually not enough by itself.  Softening the muscle contraction with a neurotoxin like botox or Xeomin will help but is temporary.  Placing a dermal filler in this region after a neurotoxin is very helpful for more complete and longer lasting correction.  We have had great results with bellafill in this region, placed with a canula technique.  This results in longer lasting reduction of the vertical lines and typically less frequent, if any, need for continued neurotoxin. It is important you have bellafill placed by an experienced bellafill injector.   Hopefully this answers your question.

Laura Riehm, MD · Answer

Thanks for your question and posting pictures.  If can be frustrating trying so many treatments and not seeing results.  While you may be able to achieve results with filler, it would only last 6-12 months.  I would recommend finding a physician's office that has multiple energy options.  After a complete consultation in a medical setting, you would probably be a candidate for a several treatment options depending on your skin type, severity of the wrinkles and how much downtime you can take.  Keep in mind that more intense/deeper treatments require more downtime, but you will need less treatments.  If you choose a short downtime treatment plan, you will need more treatments in the series.  The most gentle would be something like the PicoSure FOCUS treatment with almost no downtime.  It is safe for all skin types, but you would probably need 3 to 6 treatments.  Another option would be a fractional 1540 nm laser treatment like ICON or Fraxel.  With these treatment you could have redness and swelling for 1 to 3 days, but need less treatments.  Based on your skin type, you may be a candidate for a fractional CO2 treatment with 7 days of redness and swelling.  Look for a medical setting with a doctor in house, where they have multiple laser options.  Best of luck.

Aurora DeJuliis, MD · Answer

Your upper lines appear to be quite superficial, in my practice I have very good results using microneediling with the patient's own PRP. In order to achieve tangible results I recommend multiple sessions, at least 5 or 6 four weeks apart. Microneedling needs to be performed by an experienced physician because the right depth and the quality of the needles are key. Adding a few drops of botox will help in preventing more lines from forming.
Good luck.

Microneedling, Fraxel or something else for lines above lip? (Photo)

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