Improving “smoker’s lines”, or “radial lip lines”, is a common thing that brings people to see me. The fact that so many people have them and want them treated means that there is no single great treatment for everybody, but there are several good options. A problem is that there is at least one really bad option as well, and people often come to see me after getting this. Let me back up and tell you the story from the beginning.
Anatomy of Smoker’s Lines
Radial lip lines, or “smoker’s lines”, are the insertion of muscles into the skin and lips. The orbicularis oris is the muscle that tenses, or puckers, the lips, and when you flex it (by puckering), these lines get really deep. In youth, this is usually not an issue due to the elasticity of the young facial skin. You flex the muscles, pucker, and make any motions, and then relax and the lines are gone. As collagen is lost with time, the skin thins, and eventually they get inscripted, or etched into the skin so the lines are present at rest. This is a gradual process that depends on the skin quality, as well as the size and location of the muscle and insertion into the skin. It may have something to do with smoking as well, though I think of them primarily as a result of genetics and aging.
Lip Line Disaster
One thing that I have seen horrible results from is getting some Botox (or one of its cousins, Dysport or Xeomin) injected into these lines to make them “disappear”. It works great for the Crow’s Feet and Frown Lines, so it should work on the smoker’s lines as well, right? No. Not in my experience. By relaxing the muscle that moves the lips, the lips move less both at rest (a decrease in the resting tone of the muscle) and with movement (when talking, eating, or smiling). That is the better case scenario, with a “subtle” treatment.
The “Denture Look”
With a more aggressive treatment, you can have flattening of the lip, lengthening of the upper lip, and a “floppy looking” upper lip. The lower lip may move or not, depending if lines in the lower lip were treated with Botox. The lips roll inward, fall down, and the muscles around the lips and mouth try to compensate for the lack of movement of the lips. This gives a look that I consider to be the signature look of denture wearers when they are not wearing the dentures. It is not a look that people find desirable in the least, and my nickname for the look doesn’t do it any favors. Sometimes, when you are trying to treat something aggressively, you can get complications or results of treatment that are worse than the condition being treated.
About Those Easy Solutions to Remove Smoker’s Lines…
Lip lines are stubborn and cannot be “removed”. Don’t fall for the late-night TV ads or Instagram posts from “experts” that tell you otherwise. If it was so easy, cheap, and effective, then nobody would have complaints about these. Save your money, and adjust your expectations.
Is there no hope, then? There is, but instead of “Remove”, think about “Improve”. We have good options to improve lip lines, but removal is unrealistic and seeking this will get you in trouble. Like in other parts of the face, stepwise improvement will keep your smile looking great, and will give you reasons to smile. If it sounds too good (and easy) to be true, then be skeptical.
And stay tuned for Part II of this Blog post, where I discuss some options for how I address lip lines.
I researched botox , fillers for years and spent $$$ on creams food supplements and all the other fad gimmicks on the market . Nothing helped. I finally made the decision to go to a plastic surgeon for help. A friend gave me Dr K name . Yes, I was one of those patients telling Dr K I want my smoker lines gone!! I am so glad I went to him and got a better understanding of what these lines are and how lessen the appearance I spent an hour or so with him and returned for treatment and I am so glad I did I highly recommend Dr K!!!
I am very very happy with the results.
Lisa, Thanks for the input! We always believe that a little face to face time is more than worth hours of internet research. One thing that I see every day is people complaining of gimmicks and the amount of money they wasted on things that didn’t work before they actually got results. When they add up everything they spent on the gimmicks, it dwarfs the cost of a real treatment that gets real results.
Think about this: if a cream could help a “saggy” neck or lip lines, and this cream actually worked, then nobody would be walking around with these conditions! If they did, then they’d be seriously uninformed. This isn’t the case. Some things are just stubborn and hard to address, and they take real solutions, not necessarily “convenient” ones that can be bought online. Nobody wants to tell you this hard truth, but knowing it is a hard truth is the first step to actually going down a path that gives you visible improvement.
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Hi!
Can you help me? I totally believe that Botox won’t work for smokers wrinkles. I am thinking of getting laser treatments around my mouth as I have not read any negative about that and you don’t say one way or the other if you recommend it or not.
I found your blog very informative and candid!
Thank You so much!
Susan,
Thanks for the thoughtful question. I do recommend laser procedures, as long as they are aggressive enough. The texture changes around the lip are deep, and the only laser treatments that I would recommend here come with a significant downtime, as the resurfacing has to reach deeper into the skin. Fractional CO2 and fractional erbium laser resurfacing are the best options here. If you don’t have 7-14 days of downtime (red/pink skin, peeling), then the treatment was wasted, in my opinion. Lasers are all different, and the lower down time lasers are quite popular, because not many people have 2 weeks they can dedicate to this treatment. Lesser lasers with less down time are a waste, and will not give you the results you are looking for. If they are at a price point you can afford but the more extensive lasers are out of your range, then save your money for the treatment that will work (the fractional laser treatment with significant down time). Hope this helps!
Thanks,
Dr. Kundaria
I had Botox once and my lines above my mouth are bad now you can see where she injected it u see lips also it’s horrible I m 59 and I tried it about 6 years ago and didn’t want to keep getting them What do you recommend? I smoked till 40 but quit
Kelly,
Thanks for sharing your experience. The effects of Botox (and its cousins, Dysport, Xeomin, and Jeuveau) kick in as soon as 2 days after treatment and as late as 2 weeks. If you are greater than 2 weeks out from your treatment, then this is likely the look/result you will have until the effects wear off, which is largely dependent on dose and location of the product. Your experience is largely why I stay away from using these products around the mouth. Changes in the movement of lips and mouth are dramatic to those around you, and almost always look like something was “done”. As there is no anti-Botox, your best option is waiting it out.
As far as what your best options are today, it is difficult to say without an exam, as lips are made in several different configurations, and they also age in very different ways, so the best option for you may not be the best option for my previous patient.
Also, smoking has many effects on the face and body, but the lines around the mouth are a result of genetics rather than smoking. They are called “smoker’s lines” out of tradition rather than the cause of the lines. Most of the patients I see for these lines are non-smokers.
Best,
Summit Kundaria
I am fairly young but I do have smokers lines on the right side of my upper lip. They are very subtle but I can see them. I do receive Botox as a preventative for other parts of my face but understand it will not work for the upper lip. Due to the subtlety of my lines, I’m not sure an intervention such as laser treatment would be warranted at this timeI would love treatment but I also know nothing is risk free and I’m just not true the risk vs benefit is there. Is there anything out there (besides healthy lifestyle, skin care, spf) that could possibly slow the progression?
Grace,
Thanks for the interesting question. As you know from the article, the lines are not related to smoking, and a healthy lifestyle is the very basic thing you should do for this. I highly recommend a retinoid, such as retinol or tretinoin, as this ongoing skin care will generate collagen throughout the skin. Fillers are a possibility if you have a little volume loss contributing to the issue. Other than that, it’s hard to say much without an exam.
I’m glad you mentioned Botox, though. Botox may work for some people, but as far as I’m concerned, it is “throwing the baby out with the bath water”. You are treating lip lines with a look that is much worse than the lip lines (a mouth that moves funny is much worse than having a little line or two).
Finally, please try to be less critical of yourself. I see people that really beat themselves up (figuratively) over their faces all day long, and I really wish that people would do reasonable things to get the results those reasonable treatments can get them, and realize that your face is your face, and there is only so much you should do before you are making things worse rather than better. You have a HUGE potential to harm your young face, and I see young people that got talked into invasive treatments that ended up worse off. I’d hate for you to be one of these people. Sometimes less is more, and sometimes lines are inevitable and heroic measures to prevent and treat can give horrific results.
Be Well.
Summit Kundaria
This is a beautiful reply from you Summit 🙂
Kelly,
Thanks for the question. The effects of Botox should last for 6 months max, so I suspect that what you are seeing is your normal anatomy. The “smoker’s lines” are not actually due to smoking, and are more genetic and anatomic than a result of your behavior. Laser resurfacing as well as fillers (used judiciously) are good options for improvement in this area.
Thanks,
Summit Kundaria
My Lip lines are very deep as I have very strong muscles in my face could they be too deep for a laser to treat
Barbara,
I feel like the laser can improve all lip lines, though how many treatments you would need for your deep lines may be the question. Given that there is no “silver bullet” or “gold standard” treatment, I would be hesitant to not consider the laser, as it is effective for lip lines, and may not be all you need (since fillers are good at restoring volume), but should be considered for deep lines to complement any other treatments you are considering.
Thanks,
Summit Kundaria
I am a 50 year old woman and have the same as the lady above, quite deep vertical above lip lines.. just wondering besides laser what fillers you would use also?
I have bought an at home Rf machine.. although I think I need a little more than this to help.
Thanking you
Melanie,
I’m not sure about how effective home RF machines are, but they may help or may not do a lot. You be the judge! As far as which fillers around the mouth, something soft is best. Lately I have used Juvederm Volbella and Restylane Refyne in those areas with great results. I have also used Versa in patients with deeper lines. The secret here is to know that you can’t wipe them away without getting a giant lip, so going for 50-75% improvement and then stopping there is the best option.
As you try to get more “improvement”, you end up adding too much volume to the lip and it just looks large without looking great. Sticking with a natural look means undertreating, and using fillers to take the edge off so that the mountains are less sharp, and the valleys so deep, but settling for hills rather than adding volume until you get planes.
Summit Kundaria
I am disgusted by the lines around my lips. I look like I’m 100, at 61. I worshipped the sun for 40 plus years, with no sunscreen or preventative measures, And smoking was/is my favorite habit. My aged looks is under my my self esteem and confidence. I am on a budget but I must do something. Can you recommend someone/something In the Chicago area that could help me. I don’t want to be ripped off.
Mardi,
I would encourage you to not be so hard on yourself about the lip lines, as using words like “disgusted” to describe yourself can be a difficult emotion to address during a consultation. Though I do not know what their charges would be, I highly recommend you see a Facial Plastic Surgeon in your area to get a thorough discussion about what options are best for you. We all have different personalities and approaches, and getting a good opinion would be better than getting several “free consultations” where they make up for the price of their opinion by overselling everything that they have in their office or med spa. Good luck on your journey, and if you ever find yourself in the Charlotte area, I would be happy to see you and discuss options.
Thanks,
Summit Kundaria
I’m 61 and I have noticeable “smoker’s lines” above m6 lips. I have naturally full lips but I would also like to make them plumper. However, my main concern is “smoker’s lines”. They are destroying my self-esteem as my lips were my most noticeable feature.
Sharon,
Thanks for sharing your concerns. Balancing the desire to have more full lips while also treating the “smoker’s lines” can be done with the same filler with good effect and longevity. How you go about doing this and getting natural results depends much more on the skill of the injector than the material being injected. Knowing when to stop is a very important thing in treating lip lines, as you may end up putting in too much volume and getting a “fat lip” if you try to over treat the lines. Obtaining natural looking results cannot be overemphasized when it comes to lip fillers.
Hope this helps.
Summit Kundaria
I have smokers-lines that drive me crazy. What is the least invasive laser to help get rid of lines
Jerrie,
You ask a very important question, so I wanted to spend a few minutes answering it. You ask about a “least invasive laser”, and this is a good idea in theory. When it comes to laser treatments, or laser surgery, the “invasiveness” or the laser is directly proportional to the “effectiveness” and also the “down time”, or healing time from the treatment. Least invasive means “least effective” as well, though the healing time may be relatively shorter.
The best options in my opinion would be fractional CO2 or fractional erbium laser resurfacing, which are not the “least invasive”, though they are effective (depending on your expectations). Another important thing to note is that not all skin types are candidates for these laser treatments, with darker skin types carrying a high risk of scarring and loss of pigment (hypopigmentation).
The last key point here is that it is not the laser that is doing the treatment to your lip lines, it is the practitioner (hopefully a Board Certified Facial Plastic and Reconstructive Surgeon) that is doing the procedure, and their judgement, experience, and training is the thing that matters much more than the exact type or brand of laser they are using.
Best,
Summit Kundaria
Are there any treatments that can really remove fat or tighten skin around the neck. I have bad jowels and also double chin. Would like to avoid an all out face lift. Thank you for your time!
Danelle,
To remove fat from the neck, the two options are liposuction or Kybella, which is a fat melting injection. Which one is best for you depends on your exam, as some people do better with one more than the other. The jowls, in my opinion, are best dealt with surgically with a face/neck lift. If you do not have the funds for this, then save your money. No other treatments are effective enough to be worth spending money on, compared to saving for something that actually works. They try to use radio frequency (RF) technology to tighten the skin and jowls, and melt fat. It works in theory much better than in practice, and the results are lacking. Surgery tighten the muscle and trims redundant skin independently of each other, and remains the best option for jowls.
Hope this helps.
Summit Kundaria
I see you recommending retina but how do we use it to help with lip lines. What kind of directions for it to be most affective, please.
And thank you for your insight and time and providing such good information.
Emily, in my blog post I represent the lip lines as a “War” between the muscles that wrinkle the skin (and move your lips) vs the skin thickness. The tretinoin (Retin-A) thickens the skin. The way I recommend using it is applying it in the evening. Specifically, wash your face in the evening, towel dry, and then air dry for 5 minutes. Apply a pea sized amount to your face and fading to the neck, sparing the eyelids. Initially start once per week for 2 weeks, then twice per week for 2 weeks, and very slowly increase until daily use. Some people are unable to tolerate daily use, and use it every other day with great results. The slower you go, the less irritating it will be, and the more likely you will stick with it. Use it forever! You’ll get your best results 5 years after consistent use.
Hope this helps.
Summit Kundaria
Hello,
Which strength tretinoin (Retin-A) should I start with for my lines above my lips? Can you use this if you have laser treatment as well?
Thanks,
Trudie
Trudie,
I like the Obagi tretinoin gel 0.05%, as in my practice it is both gentle enough to be the first tretinoin product that you use, and also strong enough to be the last one that you’ll need. You can use the tretinoin before and after the laser treatment, but you should stop the tretinoin several days prior to the laser treatment (check with the provider of the laser treatment), and restart once you have healed from the laser treatment (once again, check with your laser doctor about when it is safe to restart). These are great questions.
Summit Kundaria
Hello! I’ve read through the comments and am wondering myself about “fixing” these lines around my mouth. I’ve had 4 laser treatment since 2014. One fractional, a fractional with dermabrasion, one CO2, and the last one was Sciton Erbium laser. I’ve NEVER had any problems until this last treatment. The last one with the SCITON was great but in the past month or so I noticed significant lines around my mouth like a smoker (I’ve never smoked but I use straws). I thought I had dirt or a ring around my mouth until I looked closer and it was indentations, wrinkles. I went back to the doctor that did the laser and he wants to inject with Botox. My niece says my skin has just worn out from the lasers. I’m so discouraged because I had been getting Juvaderm and was wanting to quit these injections. Any advide would be helpful because I feel as self-conscious about my face as i did before teh treatment. I have deep lines around the sides of my mouth as well (SCITON really helped that but now these mouth wrinkles) and it looks like i have a ledge around my lower lip. I’m so sad. Please advise.
Martha,
It appears that you’ve been doing good work with a combination of powered and unpowered skin surface treatments. I do not know what the time course of your issues with the latest Sciton treatment were, but the increased lines may be during the early healing period of the skin surface treatment where the skin gets swollen and lines can appear to be be deeper, then improve as the skin matures. If not, and this is a lasting thing, then my recommendations would be retinol/tretinoin to thicken the skin as well as judicious use of fillers. I prefer to avoid Botox in the lip area because I want to keep the smile as natural looking as possible. Hope this helps and gives you a place to start.
Thanks,
Summit Kundaria
To the above post I meant 4 lasers since 2010. I’m sorry for the error
Dr Kandaria
I’m 69 yrs old
I have had a lower face and neck lift … co2 laser treatment and the deep smoker lines have returned
I was told that the retinol really won’t work on such deep lines
I’ve tried filler and to me all it did was make me look like a duck
Help… what’s next
Pat,
It sounds like you had a good laser session! I would say that nothing will work on its own, as you would have heard about it by now. While retinol “won’t work”, it will help. As will fillers, more laser treatments, and possibly non-invasive radiofrequency treatments. It depends on your expectations and how much you are comfortable doing, but each intervention can be expected to help within its limits, and added up together, you will get results. Whether these results meet your expectations is the biggest question, and between you and your surgeon.
Summit Kundaria
Hey there
I have smokers lines (not through smoking)! And I just wondered what areas of the top lip would you inject and how many injections & syringes would generally be used – many thanks
I usually just inject into each line. In cross section, I see the lines as a “V” shape, and the goal is to put a little filler at the bottom of the “V” to soften the bottom of the ravine, and make it cast less deep of a shadow. My goal is usually to correct it by 50%, as anything past this will make the lip too large, and you end up with the puffy “I had filler” look. Undercorrection is the key, because the lines will never completely go away. I would only use 1 syringe, and likely not even use all of it.
Hope this helps,
Summit Kundaria
And what do you inject? Also Does micro needling do anything for the skin?
Laurie, Today my favorite injectable to use for lip lines is RHA Redensity, which is a newer filler that is not in the Restylane or Juvederm lines, so you may not have heard of it. Honestly, any thin filler that undercorrects the lip lines is what you want, as trying to make them flat will result in a thick lip (unacceptably thick!).
Microneedling will build collagen in the skin by doing controlled injury to the layer of skin that contains the fibroblasts, which are the skin cells that make collagen. It will not do anything to the tone of the skin, and will not treat pigment differences. The advantage of this is that it can be done in all skin types and can build collagen in all skin types.
The lasers that people use in this area are not safe to use on all skin types, but may be a better option if you have a lighter skin tone.
Hope this helps.
Summit Kundaria
I will be 72 in May. I am more and more bothered by vertical lines above my lips. I simply caan not imagine them getting worse and worse over the next 10-15 years. My research indicates the best option would be laser treatments. I have been unable to learn the longevity of the treatment. I do not want to have to repeat the procedure more than a time or two, before I get to the age that it’s ridiculous to continue. Also, I wonder if you could recommend someone in the State of Maine. Thank you!
Karen,
I do not know if there is a single “best” treatment for this area, as no single treatment modality targets all of the anatomic reasons that one would get lip lines.
It really depends on how fast you need results (filler is the most “instant” treatment), your skin type (no lasers on darker skin tones”, cost (lasers cost more than micro needling), and time (lasers and microneedling take months to build collagen).
If you are shopping for a laser treatment, my recommendation if you are looking for having the fewest treatments with the most results is a fractional CO2 laser treatment with 1-2 weeks of downtime. Ask your doctor for before and after pictures for patients that they personally have treated (not from the company that makes the laser) and make sure the doctor will do this treatment with their own hands (and not hand this off to a midlevel practitioner). The laser brand is much less important than the person using it, just as the scalpel is an instrument that can be used to perform a facelift or shave the skin. That said, a laser that is just too superficial will not get into the depth of the wrinkles to resurface them, so you need an appropriate laser in the hands of someone that can get you great results.
I do not personally know of any facial plastic surgeons in Maine, but you could expand your search to include Dermatologists that specialize in cosmetics as well. Make sure that you are getting this treatment by someone that is specifically trained in the field of facial aesthetics, and is not a general doctor that took a “weekend course” about how to use a laser and is a self-branded “expert”. Most lasers are more superficial and lower risk, giving you less down time and less result. These are the lasers that populate most of the med spas and offices where midlevel practitioners and non-Dermatologist and non-Plastic Surgery trained people use. The low down time for these lesser lasers is a big selling point, as most people do not have 1-2 weeks of downtime to get serious results. Avoid these. For lip lines, “fractional erbium” and “fractional CO2” are the flavors of laser you are looking for.
Do not confuse a fractional laser with any other “fractional” treatment, as there are mane “fractional” needling treatments that use needles under the skin to apply heat energy to build collagen. This is not a laser and is not as effective. As a general rule, if they are trying to sell you a “package” of treatments, run. If it’s not powerful enough for you to see results from a treatment, then it’s not worth buying a package of them.
Hope this helps.
Summit Kundaria