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.