What can I do about my vertical lip lines?
The appearance of vertical lip lines above the lips can make you appear and feel older than you are.
People will point to these lines and exclaim how much they hate them.
As with any solution, we begin by understanding the specific anatomic issues before developing a treatment plan.
I’ll discuss how I address vertical lip lines and lip appearance in my practice.
It is all too common to chase lines in the aesthetic field. This means to either plump the lines with fillers or resurface the lines with chemical peels and lasers.
I take a more global perspective when a patient expresses concern about vertical lip lines. For example, I look at the volume of the lips as well as the projection of the cheeks and chin to see how the overall aesthetics can be balanced such that the lip lines are not the main focus when you look in the mirror or are engaged in a social interaction.
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I start every consultation by taking photos from several angles and I placed these photos up on a screen so that my patient can see themselves in a more objective way.
It’s common for people to lose perspective by focusing on one area and magnifying that specific issue, while not recognizing the context in which this issue is part of other significant anatomic features.
My analysis always begins from the inside outward.
The cheek and chin bone structures play an important role in the way the lips appear. I show my patients how sagging cheeks, a receding chin and downward turning of the outer corners of the mouth are contributing to the overall appearance of the area around the lips.
There are some situations where a younger person has some isolated lines which can be treated without any other areas needing attention.
Generally speaking awareness of vertical lip lines is a significant concern for lighter skinned women who are in their 40s and older.
Often there is a family history, which makes this a genetic trait that can be made worse by lifestyle factors, such as smoking and excessive sun exposure.
At the skin level these lines are due to a loss of collagen in the dermis or backbone of the skin. As collagen diminishes in the dermis, the skin loses strength and support, so lines, wrinkles and folds develop.
In addition as we age we lose volume, especially in the face from diminishing bone muscle, skin thickness, fat and soft tissue. The lips can lose volume and soft tissue, causing once full lips to look deflated.
The action of a muscle around the mouth, called the orbicularis oris muscle, can also contribute to the formation of vertical lip lines. This is the muscle that is active when you pucker, drink through a straw or smoke.
As in other areas of the face, I look at the lines as static, which means present at rest, and dynamic, which means deeper with muscle contraction.
Lines which are deeper and causing static lines to develop because of repeated action, I treat with the botulinum toxin, such as Botox, Dysport, Xeomin and Jeuveau.
I look at the volume loss below the skin where vertical lines exist as a natural extension of the volume loss occurring in the lips.
If you think about it, the lines would not appear as significant if the lips appear to be more full. The art is to enhance the lip volume so the lips look natural with the rest of the face.
I find that people are so afraid of looking overdone that I have to place minimal volume into the lips and then add more in a few weeks if they want more volume.
I use softer hyaluronic acid fillers such as Restylane-L and Juvederm XC for the purpose of lip volume enhancement and restoration of volume directly below the vertical lines.
I also use softer fillers like Restylane Silk and Juvederm Volbella when I treat individual lines at the level of the dermis.
When you look only at the skin quality, there are two basic issues.
One is the loss of collagen in the dermis and the other is the surface irregularities in the epidermis, which is also a reflection of the contour within the dermis.
This is where I need to create a customized treatment plan specific to your skin.
I have successfully treated this area with fully ablative and fractional erbium and CO2 laser.
The downside of these options is the healing process. The epidermis needs to heal and the skin can be raw and red for weeks afterwards.
I found that although people were willing to deal with this recovery in the 90s and early 2000s, tolerance for what is perceived as longer healing periods is less than it’s ever been.
I’ve also found that once there is improvement with fillers, there’s often less motivation to pursue more aggressive treatments.
Before and After
I’ve developed treatment strategies to improve the skin quality, which do not require any downtime. For example, to help improve the skin quality I use PRP or platelet-rich plasma.
PRP is the concentration of wound healing and growth factors present in the blood, which are activated when you have a cut.
I deliver the PRP with a special device directed towards the dermis without any bleeding or making the skin raw.
In addition to PRP, I use hyaluronic acid in the same device to provide a scaffold for the collagen generated by the PRP to build upon.
We call this procedure skin boosting and the patient comes in at regular intervals to build upon the collagen induced by the previous treatment.
I often combine skin boosting with a non ablative laser such as a Q-switched laser and a 250 microsecond and Nd:YAG laser, we call laser skin toning.
I described this as similar strategy to building muscles with weight training.
The epidermis can also be improved with minimal downtime with a lighter fractional laser and long pulsed Erbium laser.
We also use a water-based microdermabrasion technology called hydro facial, which exfoliates and hydrates the skin without any downtime.
In the current marketplace, commoditization of products and procedures has overshadowed the value of a highly trained and experienced doctor to be on your side.
Since companies sell lasers and injectables, the marketing is focused on the tools and not the practitioner. Non physicians and physicians with limited experience in the core aesthetic specialties have created a false equivalency in qualifications, which consumers are just not aware of.
Every treatment carries risk!
For example, the lip is a very vascular area and filler can be injected directly into a blood vessel, resulting in a vascular occlusion, where blockage of a vessel or artery can lead to a catastrophic tissue loss.
So regardless of how many Instagram followers the injector has, the patient who has his event, has to be referred emergently to a physician who was a specialist to deal with the complication of this injectors treatment.
In a marketplace where transactions are more important to the sellers than long-term consequences of any given procedure, I recommend that you be your own advocate and invest your time and resources in an aesthetic specialty physician who will be there for you for the long term.
By New York facial cosmetic surgeon, Amiya Prasad, MD.