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Stepwise improvement in lip lines addresses the anatomy of lip lines without trying to relax, or paralyze the orbicularis oris muscle, using Botox.  The appearance of lip lines is due to the presence of the muscle inserting into the skin around the mouth (so that the skin moves with the muscle), and the overlying skin, which loses collagen and elastin with time, leading to thinner and less elastic skin.  As we want to avoid the “Denture Look”, our options are mainly aimed at thickening the skin around the mouth.

Skin Care for Smoker’s Lines

The best results for lip lines will be with the use of retinol or one of its more powerful cousins like tretinoin (Retin-A).  This puts the skin into overdrive and increases thickness and skin quality, and it plays well with the other modalities we discuss in this post.  Over the counter retinols can be found everywhere, though I recommend something more powerful, such as tretinoin.  Our patients have had great results with Renova, which is a tretinoin combined with a moisturizer.
An additional boost to the skin texture can be obtained with hyaluronic acid products, of which there are several.  The one I prefer his the SkinCeuticals HA Intensifier, which increases the skin’s production of hyaluronic acid rather than just spreading it on top of the skin.  This gives a more lasting result as the topical hyaluronic acid products only work as long as the compound is on your face.

Microneedling for Smoker’s Lines

Stimulating collagen production in the skin can be done in several ways.  The most gentle on the skin would be aggressive microneedling, which can be done on all skin types.  I like microneedling because it is less likely to cause pigment changes, which can be bothersome in darker skin types, but also can be seen in lighter skin toned individuals.  Multiple treatments are usually required, and the downtime is usually a day or two depending on how the skin reacts.

Laser Resurfacing for Smoker’s Lines

Fractional erbium and fractional carbon dioxide lasers work by creating columns of treated skin surrounded by untreated skin, and these columns penetrate into the skin and trigger a collagen building response.  The downtime with these treatments depend on the treatment settings, but for great results, can take 7-10 days.  As the skin heals from the treatment, it thickens and surface irregularities get smoothed out.  The best results from these treatments can be seen 6 months after the treatments.

Radiofrequency Treatments for Smoker’s Lines

There are several radiofrequency, or RF devices on the market right now, and they all work in a slightly different way.  Some technologies like ThermiSmooth apply the RF to the skin surface, while others such as Vivace and Inifini use needles that penetrate the skin to deliver the energy.  I have delivered several treatments with such machines, and have never been convinced that the results are better than microneedling alone.  Furthermore, the cost of these treatments can be quite high.  Until I have seen good results, I remain rather skeptical about the improvement that can be expected from these devices.

Fillers for Smoker’s Lines

Dermal fillers, such as Restylane, Volbella, and Versa, can be used to soften lip lines with great results.  They can be done before or after the treatments described above, and in my opinion, give the best “instant gratification” of the modalities on this list.  They can be done alone, though they work much better when paired with some of the other treatments listed above.
My goal with fillers in the lip lines is undercorrection, as the upper lip can only accommodate so much volume.  If you think of each lip line as a valley, then the goal is to make the bottom of the valley less sharp and less deep.  Trying to make it flat involves using so much volume that it gives an unnatural look.  I have found patients quite happy with these treatments because of the subtle stepwise improvement without getting a thick upper lip.

Conclusions

The take home point in this two-part series about lip lines is that these lines are stubborn, usually require more than one treatment modality (such as lasers, microneedling, and fillers), and should not be treated with Botox.  Sticking to these along with a healthy attitude about expecting “improvement” rather than “removal” will keep you safe and smiling.