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 retinol 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 under-correction, 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.
Your article on Smokers lines is very informative. I’m currently using Retin A on a dark spot in my cheek. I have lines, that I hate, above my upper lip.. can I use the Retin A cream on these unwanted lines? Can I also use the Retin A cream on some spots I have in my chest, above my breast & on the side of my neck? Thank you very much
Adriana,
I have confidence in recommending Retin-A on the lip lines and whole face. Personally, I do not have experience with using this below the neck, though the neck is far game! My practice is limited to the face and neck, and I would say that the effects are really great, though I do not think they are enough to make significant improvements on stretch marks, which are deeper than the effects of Retin-A would expected to be.
Thanks,
Summit Kundaria
Excellent article. I’m experiencing some of these
issues as well..
I’ve tried the fillers route for the lip lines,it does minimize but you have to continue doing the process 4 ever..something alittle more permanent would be great..any suggestions?? Also..ive been using retin A for years and it hasn’t done anything for the sun spot on my cheek, what else could I do? Thanks
Margo, for your lip lines, a skin thickening treatment such as laser resurfacing or chemical peel may be a good next step. It plays well with the fillers and Retin-A, and thickens the skin by another route. Building collagen in the skin will help resist these lines and make them less deep.
For the sun spot, a laser resurfacing treatment, IPL Photofacial, or Obagi Blue Peel along with prescription strength skin lighteners (like 4% hydroquinone) can be a great combination to get improvement. Which of those options you choose depends on down time, cost, and the appearance of the spot.
If you have any other questions or would like to schedule a consultation, please call or text the office at 704-593-6802.
Once the micro needling treatments have reached the desired look, how long will it last?
Marci,
The effects of micro needling are dependent on the individual as well as the depth of treatment. You see, the treatments are aimed at building collagen, and how long collagen lasts depends a lot on the individual. Some people are at a stage in life where they are losing collagen, and others are building it. Results are generally proportional to the depth, or “aggressiveness” of the treatment. The more aggressive the treatment, the longer lasting the results. Also, the younger the patient, the longer lasting the result, as they are building collagen more and losing it less. If you want any more information about micro needling, give us a call at 704-593-6802
Please can you advise me on microneedling ?
My main areas of concern are lip lines and forehead . I have good skin and aged 54.
I’d like to purchase a home kit but need advice about depth and number of needles
Thank you
Julie xx
Julie,
Thanks for the question. It’s really hard to advise you without an exam, but for lip lines and horizontal forehead lines, you are best off with the deepest that you can go, as you want to stimulate collagen at the deepest level to thicken the skin. I am not sure what depths are available for home use, and I am not familiar with results you can get with these. In the office, we have medical grade micro needling devices with 36 needles in a cartridge, and can adjust the depth of penetration to more than 2.5mm, if that gives you something to compare to. If you were my patient, I would likely use the depth of 2.5mm to get the best results, and expect 6 sessions of monthly treatments before we get a visible improvement. Hope this helps.
Dr. Summit Kundaria
How much would the 6 sessions cost Dr.?Thank you.
Check out our pricing page for the most up to date pricing. I’d hesitate to quote you something without an exam, so this page should be a rough guide for a package of treatments with our aesthetician.
https://www.nuancefacialplastics.com/home/about/pricing/
I’ve had Belleville recently was this a good choice for lip lines?
Ruth, I think you are talking about Bellafill, which is a mixture of cow collagen and plastic microspheres. I no not use this product due to safety (the cow collagen can give rise to allergic reactions, unlike newer, safer fillers) and long term effects due to the plastic being injected. I have seen some scary cases of that filler forming “sausages” or other irreversible soft tissue complications. The double edged sword of longer term results and also longer term complications is very evident with that product. The only thing that matters is you experience and results, so if you are happy, then it was a good product for you in this situations.
Thanks,
Dr. Kundaria
I am 55 have very light skin that is sensitive and very oily and still have acne. The only thing that ever cured my acne is oral Accutane which I’m considering taking again. I’ve been using Retina A for years and it hasn’t helped my lip wrinkles or acne. 1 year ago I tried a fibroblast treatment which left me with brown dots mainly on my lower cheeks. The lady who did the fibroblast tried microneedling which left me with tiny little wholes all around my eyes and did nothing for the brown spots. I’m at a point where I’m afraid to try any thing new.
Rhonda,
Thanks for your insight! I agree that Accutane has no replacement when it comes to difficult acne. Fibroblasts are the cells that make collagen, so the microneedling treatment was likely aimed at building collagen, and possibly used “growth factors” which are over-promised, under-delivering, and costly “add-ons” to micro needling. Microneedling is generally thought of as a benign, skin-neutral treatment that improves texture without affecting color, which is great because it can technically be done on all skin types, though I still use caution in darker skinned individuals, as I have seen darker skinned patients get pigment issues with treatments that are too aggressive for their skin type.
I’m sorry you had such a bad experience, but there are treatments that can be done for brown spots on all skin types. A good (prescription strength) skin care regimen paired with IPL Photofacials, VI Peels (chemical peels), and laser treatments can improve dark spots quite well, though not every one of those treatments is safe to do on all skin types. A discussion about expectations and coming up with a game plan is a face to face discussion in my office.
Best,
Summit Kundaria
I have heard that women who have had breast cancer should not take hyaluronic acid supplements so I am wondering if micro needling with it would be safe.If not is there something else that is is used alternatively
Diane,
Thank you for your question. There is no published medical evidence that says that breast cancer survivors cannot use hyaluronic acid for cosmetic treatments. I do not know about oral supplements, but the cosmetic use is considered safe and has no interplay with a history of breast cancer. Microneedling treatments that involve hyaluronic acid or injectable fillers are considered safe and should not impact any treatment or monitoring of breast cancer patients. Hope this helps.
Summit Kundaria