This is a question we hear almost every day from a patient. These lines can manifest as vertical lip lines (so called smoker’s lines), deep lines going toward the chin (marionette lines), dimpling of the skin around the chin, or downward turned corners of the mouth. Most patients have a combination of these problems.
A common misconception about vertical lines on the upper lip area is that they are mainly from smoking. While it is true that smokers often have these lines, they can happen as part of the aging process on many people who never used tobacco. These lines are usually made worse by muscle hyperactivity from the underlying lip muscle. An easy way to tell if this is the case is to pucker up in front of a mirror-the lines you see from this maneuver are the ones from muscle contraction.
The troublesome areas around the mouth require a multiple approach to treatment.
The lines from muscle hyperactivity can be treated with small amounts of Botox injections Using Botox to relax muscles around the mouth will result in fewer lines due to muscle activity. This should be done judiciously, as overtreatment or poorly applied Botox can result in asymmetry or difficulty drinking through a straw. Botox is also effective in treating dimpling of the skin along the chin as well.
Other superficial lines can be filled in using “filler” materials, such as Juvaderm, Restylane, or Boletero. Filler materials are used to fill in wrinkles, by raising the skin of the wrinkle. These treatments offer immediate results that can last up to a year. If desired, lip enhancement can also be performed simultaneously using these products.
The marionette lines can be filled in using deeper fillers, such as Radiesse or Voluma. These fillers are injected during a short office visit, and patients can see immediate results, lasting up to a year. Once patients develop deeper lines, a skin tightening procedure is necessary to effectively treat the area.
For patients seeking a more permanent improvement, perioral dermabrasion or a skin tightening procedure are appropriate options. Dermabrasion is a method to lower the thickness of the skin around a wrinkle. It is a minor surgical procedure where an abrasive wheel is used to even out the skin thickness around the wrinkles. Once healed, the skin is typically smoother and tighter.
Developing lines around the mouth can be an area of great frustration for many patients. However, with the correct application of the above treatments, most patients can obtain satisfactory results in a short period of time.