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

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!"  

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

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.