Lip Lines: A new approach

Lines on the upper lip tend to drive people, especially women, crazy. Lipstick tends to creep up and accentuate these lines. These lines are caused by folding of the skin by the orbicularis oris, the muscle that encircles the mouth. They're commonly thought of as smoker's lines, but for most people these days, they're really talk and expression lines. If you stand in front of a mirror and pucker your lips, you'll notice that each line occurs at the bottom of a fold. Unfortunately , not talking and not having any facial expression doesn't seem a reasonable approach to eliminating lip lines. That's why the use of Botox doesn't play a big role around the lips.

Lip lines extraordinarily difficult to treat effectively, probably because the area is in almost constant motion. The definitive treatment is resurfacing of the area, but mild resurfacing is not enough. Only fairly aggressive resurfacing works and that means the CO2 or Erbium YAG lasers (Before and after Erbium YAG lip photos) , true dermabrasion or the phenol based peels. All of these methods are accompanied by significant downtime and they all will eliminate discolorations of the skin in the area treated. Thus unless a person has very good looking skin, except for the wrinkles, or unless they are willing to make the lip color match the rest of the skin color on a daily basis, it becomes necessary to treat the entire face to get a natural looking result.

Milder resurfacing approaches, such as the microlaserpeel  (MicrolaserPeel information) unfortunately do not produce long lived results on the upper lip.

Another approach has been to use fillers to fill the upper lip lines. Initially Collagen was used, but although the results  were good, they were very transient. More recently the Hyaluronic acid fillers have been used with variable results. They last longer than collagen, but still survive only for about 6 months. Furthermore they can sometimes leave lumps in place of the lines.

Recently we have mastered two new techniques that improve results. The first of these is the "Fern Pattern" technique (Fern Pattern information) which was invented in the Netherlands and has primarily been used with Restylane. It allows the filler to be injected very superficially in the skin and this eliminates the problems with lumps. It also appears to improve the durability of the implant. Finally, we have now learned how to inject Juvederm in a similar fashion through a very small needle, high up in the skin. Juvederm is also a hyaluronic acid filler, but is a bit thicker and stiffer than Restylane. It is our initial impression that the Juvederm gives even better results than the Restylane. Neither of these treatments is associated with any significant down time and I've never seen bruising occur with these very superficial injections.The following photos show before and after photos of lip lines treated with Restyane using the Fern Pattern technique (upper pair) and Juvederm using the fine needle technique (lower pair). Although the top patient has more lines, the improvement is perhaps 50%. In the lower photos, the improvement is about 80%. Either approach is a significant improvement over previously available techniques.

Gerald N. Bock MD

Stockton, CA

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