Managing Fine Lines Around the Mouth

Fine lines around the mouth is perhaps the most important and at the same time least important topic for a written blog on facial plastic surgery.  Why is that the case?  Because almost every woman young and old is bothered to some degree about what they call “smoker’s lines” but in over 85% of the cases no one else looking at that person can even see them.  The reason for this disconnect is that most women believe that these lines make them look old and they look too closely at themselves with a very magnified 8x or 10x mirror when they remove their makeup.  Or when they put lipstick on, they see a small bleed of lipstick go through the wrinkle and then become alarmed.  I also hear, “But it makes me look like my mother” or “Can you believe it, I have never even smoked!”  Most oftentimes the best treatment for these lines is not even to treat them at all but to help a woman stop seeing herself at this extremely close range in which every micro flaw looks terrible.  It is the least expensive and most effective method to fix the problem, which is to stop looking at it.

Treatments for Smokers Lines

Smoker’s lines are the greatest fear for many women.

Okay, now let’s talk about concrete ways to fix the fine lines around the mouth if they really truly bother someone or in fact they are something that as a plastic surgeon I even see from a casual distance.  It is perhaps best to break this problem into two stages:  early and late wrinkles.  Early wrinkles appear only or principally when one puckers and has a small residual presence when one is not puckering.  Late wrinkles on the other hand are truly visible from even a social distance, i.e., they are deep gouges in the upper and lower lip that look like advanced smoker’s lines.  By dividing the problem into these two types of wrinkles we can come up with an effective strategy that is tailored to the problem at hand.

For early wrinkles, it is best to treat the cause and not the effect.  The cause is movement that produces the wrinkle:  the effect is filling the line itself with a filler like Restylane, for example.  To treat the cause, we must stop the movement.  We do this simply by evaluating if there are certain activities that exacerbate the wrinkles.  These would include pursing one’s lips all the time (bad habit), drinking from straws (good for teeth but bad for wrinkles), drinking soup, drinking out of water bottles, and of course, smoking.  If one can at least eliminate many of these activities, these early wrinkles can oftentimes fade without further need for intervention.  However, if this is not enough to accomplish the task, then Botox is a great way to train one’s mouth muscles to stop creating these wrinkles.  Botox typically only lasts for 6 weeks and is charged at a modest cost.  Even though Botox lasts a short time, if repeated every 6 weeks for 4 to 5 rounds many times whatever small habits were there that caused the wrinkles start to diminish and the need for ongoing Botox is unnecessary.  The next step if this does not manage the situation is to use a filler like Restylane to fill the small line.  Although Restylane is temporary and oftentimes short lived (lasting in this highly mobile area only for a period of 6 weeks to 3 months), repeated treatments can create sufficient collagen growth that some long-term improvements can be seen in many cases (but not always).  I have also used permanent silicone microdroplets but they are not always effective for very early lines and caution must be exercised not to overfill these lines with silicone.

For late, or advanced, wrinkles, Botox and fillers oftentimes are not enough to make the area look good enough.  Fillers are still effective but there is a better way to create more durable and more visible results.  That would be dermabrasion.  Dermabrasion is not to be confused with microdermabrasion, which does absolutely nothing for this kind of wrinkles.  Dermabrasion, or mechanical dermabrasion, is a high-speed sanding down of the skin surface by a trained physician or surgeon that leaves the skin weeping and raw for a few days and requires up to 10 days for full recovery.  Anything short of this treatment is ineffective.  I have personally tried fractionated lasers, plasma, chemical peels and many other resurfacing methods with really insufficient improvement.  Mechanical dermabrasion really is required to make the changes necessary to improve these late wrinkles.  By categorizing a wrinkle into early and late, the physician can more accurately guide a patient to the desired treatment strategy.

Follow the links to learn more about Dr Lam’s cosmetic lip proceduresRestylane and Botox including before and after photos, videos, forums and FAQs, or call 972.312.8188 to schedule a consultation .