Smokers lines (the wrinkles above the upper lip) are not always from smoking and most of my patients who have lines and wrinkles in the upper lip area are not smokers.
Dynamic lines and static wrinkles in the upper lip need a multipronged approach to treatment because:
The area is dynamic and the muscles are not only expressive but functional (speaking/eating….you get the picture…) so using muscle relaxing injections will help but the dose needs to be kept low and distributed evenly
Poor skin quality due in this area is unforgiving and contributes significantly to the wrinkles
Excess volume in this area (from the wrong filler) will distort the face and make the area look unnatural
My approach is to use a combination of treatments as follows:
Tiny doses of strategically placed muscle relaxants
This weakens the muscle around the mouth without disturbing function. Because minute doses are used, the doses need to be repeated every 8-12 weeks unlike frown lines which can be repeated 4-5 monthly.
Judicious use of filler
Filler choice is of crucial importance. The filler chosen depends on:
Tissue coverage (the thickness of the surrounding skin)
Surrounding volume loss in the lips and mouth
As a rule I assess any volume loss around the mouth and lips and treat this with the appropriate filler. Very often this reinflation of the tissues will hydrate and plump many of the wrinkles away. If there are wrinkles remaining or if the patient has naturally full lips, I do not continue to add volume but then look at layering a smaller dose of a thinner filler directly into the lines.
There are a wide variety of top quality fillers now days and I would choose one with more cross linking (ask your doctor to explain because I can’t mention brand names here) that was soft enough to be placed high up in your skin, close to the surface without causing lumps or a blue tinge to your skin.
Improving skin quality
Excellent skin quality means you look healthier, younger and less tired. But the skin you have after the age of 40 depends on genetics, lifestyle, sun-exposure, and medical history. Most Australians do not have the skin type suited for this climate and show signs of premature ageing. Skin treatments that been proven to work :
Zinc based daily sunscreen/Anti inflammatory foods and supplements (another blog post)
Retinols and glycolic acid daily and in concentrated infusions (in clinic) – stood the test of time
Ablative laser resurfacing is the most effective skin treatment for wrinkles