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28.01.2016
Lip lines, particularly the vertical wrinkles of the upper lip, are a common problem amongst many Caucasian women.
In the November 2009 issue of the Aesthetic Surgery Journal,  a study was reported to investigate the differences between men and women around the mouth area.To determine how bad the wrinkles were, the upper lip of male and female fresh cadavers were analyzed using three-dimensional digital imaging and as well as histologic assessment of full-thickness lip resections in different male and female cadavers. This study provides scientific evidence as to why women are more susceptible to the development of mouth and lip wrinkles.The skin around the mouth in women has lesser numbers of skin appendages (hair follicles and oil glands) as well as different connections between the skin and the muscles of the lips.
The key anatomic factor is that with less oil glands, there is less oil production to help keep the skin softer, smoother and better protected. Outside of this study, there are likely other contributing factors that accentuate these anatomic findings.
While avoiding smoking and sun exposure and using daily moisturizers are extremely helpful and will reduce the amount of wrinking which will develop, that advice does little for the women who already has significant signs of mouth aging.
Several treatment strategies exist that can help significantly with lip lines and wrinkles. The anatomy of lip wrinkles indicates that no matter what is done, none of the treatment approaches actually ‘cures’ the problem. I read a recent article that reports that drinking directly from water bottles can cause just as many upper lip wrinkles as smoking. As a general principle, wrinkles form on the face perpendicular to the direction of action of the underlying muscle movement.
One of the seemingly ‘simple’ but most difficult cosmetic facial problems that I see in my practice is the woman with upper lip lines. The two basic treatment approaches are injectable fillers (JuvaDerm or Radiesse) placed directly into the vertical lip lines or laser skin resurfacing. Disclaimer: The information contained on this website should not be construed as medical advice. While upper lip lines are often perceived as being caused by those smoke (and this certainly is a contributing factor), but many other factors contribute as well.
The treatment of upper lip lines is challenging because the source of the problem, movement of the mouth, is something that can not be changed after surgery. Other lip skin resurfacing methods are available including the dermaroller and old-style dermabrasion.
The best upper lip line reduction therapies incorporate a combination of skin resurfacing and volume addition. The key word to use in the treatment of vertical lip lines is reduction, few patients will achieve complete elimination of them in a single treatment. One of the features of facial aging that bothers women the most is the development of upper lip lines. Many patients think it is due to smoking and chronic sun exposure (and clearly these can make a big contribution) but the reality is…it is a function of full your lips are and how thick your skin is. While Botox can certainly weaken the muscle movement and cause less puckering, it must be done carefully so as not to create an unnatural lip movement with smiling. Being able to reduce lip wrinkles gives your smile a chance to shine and your face a youthful look. Thinner less pigmented skin is more prone to wrinkling due to repeated lip motion and less dermal thickness and elastic fiber content.
Women know these signs very well and they include such areas as the back of one’s hands, the neck at the sternal notch area, and the mouth. I think the observation that the muscles around the mouth are closer to the skin in women than men is also important.
These include injectable fillers, Botox, laser resurfacing, chemical peels, and fat injections. The skin of the lip can not be made permanently thicker and the natural oil production of the skin can not be improved. I wouldn’t doubt it as any activity that makes your lips pucker, which activates the orbicularis oris muscle which encircles the mouth, can cause wrinkles to appear on the upper lip. For example, horizontal forehead wrinkles are the result of ther vertically-oriented and moving frontalis muscle which extends from the brows upward into the scalp. One method is to combine laser resurfacing with the use of sandpaper (yes I said sandpaper), known as laserbrasion. Injectable lip fillers, laser resurfacing, and Botox can help but there is no permanent cure.
Like dark spots on the hands, these telltale signs of aging are very disturbing for the aging woman. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience.
The most significant, as previously mentioned, is light skin pigment and a genetically thin upper lip. One can adopt a new diet to protect a liposuction result or avoid the sun and do numerous topical therapies to preserve other facial surgery changes, but one can not change the thickness of the upper lip or stop eating, drinking or smiling after lip line treatments. Using deeper laser treatments, the objective is to bring down the entire epithelial thickness of the skin and cause some collagen thickening as well.
For very deep lip lines, dermabrasion provides the most aggressive method of ‘sanding’ that actually produces the best results. Most patients think this means trying to directly inject the vertical lip lines, and this can be done for the very deepest ones, but it really means augmenting the size of the upper lip vermilion. If done in the office, fractional laser (22%, 100 microns) with Juvederm upper lip injections is my preferred technique done under topical anesthesia.


This is why this is much more of a problem in Caucasians of northern European and English descent than it ever is in African-Americans, southern Europeans, or those of Mediterranean origins. Since you can’t cure the cause of the lines (thicken your skin or stop moving your mouth), I tell patients to think about improvement (but not elimination of the upper lip lines) and the need for maintenance treatments as we are not curing the root of the problem. For this reason, this is usually the last procedure I will do or will do it only in combination with everything else in the most severe cases. The wrinkles form perpendicular to the horizontal orientation and sphincteric movement of the underlying orbicularis muscle.
Men had a significantly higher number of sebaceous, sweat glands, and blood vessels in their skin.
This may allow the muscles to pull the skin in tighter, creating a ‘purse-string effect’ and causing more wrinkles. The fundamental concepts of these strategies (with the exception of Botox) is inflation (volume fill or restoration) and smoothing. The development of such wrinkles is a function of both the activity and how often it is done. Since the mouth’s main muscle (like the eyes) is a sphincter or encircling muscle which lies parallel (horizontal) to the upper and lower lip (except at the corners), it is no surprise that the lips (particularly the upper) develops vertical wrinkles in some people. For small and fine lines that are mainly located at the junction of the skin and the lip, an injectable filler can make a nice improvement…if you can accept having slightly to substantially larger lips. With this technique, the laser is only used for the first pass (to remove the very top layer of skin) and the deeper layers are then taken done by fine sandpaper. The alternative treatments of fractional laser treatments, laserbrasion, and collagen induction therapy are interesting but it is too early to know if they will offer better results.
Ironically, I have seen them even in some younger patients, so it is not always a sign of aging! These are simple office procedures that are done under a local anesthetic to numb the whole upper lip through traditional dental block techniques. Essentially, a roller with many fine needles is run over the upper lip (like aerating your lawn), creating fine tunnels into the deep part of the skin. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. Such lip lines are very bothersome to women as they not only suggest an older lip but also cause problems with lipstick, often bleeding into the lower end of the vertical line. This means that the upper lip has thin skin thickness and less subcutaneous fat which offers little buffer from the motion of the underlying circumferential orbicularis oris muscle. Much like sanding an irregular surface, significant reduction in lip lines can be achieved by total ablative laser treatments.
But it is a highly technique sensitive method of resurfacing and is prone to a higher risk of hypertrophic scarring and severe skin thinning. This will  increase the size of the upper lip which directly plumps out the lower end of the vertical lines as they join into the pink part of the lip.
If done in the operating room, as part of a facelift for example, then I would do a more ablative laser treatment (two passes) with fat injections into the upper lip. As all natural wrinkles form perpendicular to the direction and action of the underlying muscles, vertical lip lines develop from the action of the circumferential orbicularis muscle that purses your mouth around a straw, cigarette, or puckers for that kiss.
Keep in mind we're not talking about upper lip lines and wrinkles but rather wrinkles of the lips themselves.While some people naturally have little groves and lines on their lips others notice they tend to develop more with age.
Your smile will benefit greatly from simple things like:Lip Plumpers are a great way to fill-out those tiny lines and get fuller sexier lips too. Regardless of how they form, they are very pesky problems to treat so prevention plays a critical role. As a plastic surgeon, the mouth seems to be an area that unfairly ages in women much more than in men.
Somewhat surprisingly, the number of hair follicles did not significantly differ between men and women, although men had a higher number of sweat glands per hair follicle. Coincidentally, women on hormone replacement therapy have been reported to have fewer wrinkles than those not taking the hormones.
While everyone does not need all or even most of them, a combination of inflation and smoothing will work better than just one of the concepts.
Drinking water these days for some people is about as frequent as a regular smoker who does one or two packs per day. The other factor that highly contributes to lip wrinkles is the thickness of your skin and the size of your lips.
The concept here is that the use of sandpaper causes less trauma (no heat) and will heal faster without the prolonged redness. While frequently thought of as being due to smoking or excessive sun exposure (and these certainly are important contributing factors), it is as much due to the native thickness of one’s skin (racial type) as well as how one moves their face with expressions than anything else. Neither of these approaches ‘cures’ the problem, but significant improvements can be obtained.
Topical vitamin C preparations are then applied after so that they may ‘soak’ into the tunnels and stimulate the underside of the skin, causing it to thicken. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. By far, vertical lip lines occur most commonly in Caucasian women of Northern European descent. But it can thin out the skin, cause pigment loss and can not usually be done more than once if the initial laser depth was deep.


The dermaroller is very much like a poor man’s fractional laser that punches small holes in the skin but its ability to induce collagen production is not as powerful and multiple treatments are needed to approximate even one laser resurfacing.
For those women that do not mind some increase in their lip size this is an essential step in a lip line reduction strategy. Either way the patient needs to be aware that lighter maintenance fractional laser treatments will be needed in the future. Usually, this is due to collagen reduction, which thins the lips and leaves the delicate skin lose and wrinkly. Stopping smoking is one of the most important preventers as its toxins damage collagen, resulting in fine lines.
It is actually rare to see deep vertical lip lines in men, even if they have thin lips, until they get quite elderly. Also, most men perform a daily wrinkle treatment, shaving which is a  form of microdermabrasion. Usually this means laser resurfacing and it is just a question of how deep to go and how much recovery does the patient want. And it is just as effective as the laser but safer and with less complications than if one used traditional dermabrasion. These can be easily shown by looking at African-Americans, Hispanics, and people of Middle Eastern or Pacific Rim descent who have much thicker skin (more dermis and elastin fibers), it is very rare to ever seen upper lip lines in these ethnicities.
So rather than burning the top layer of skin off (laser resurfacing) to soften the wrinkles, this approach focuses on stimulating the skin to thicken. They are very rarely ever seen in women that have more skin pigment, thicker skin and fuller lips. Thus enters the concept of fractional laser resurfacing where the risks of skin thinning and color loss is minimized. The best results that I usually see is when the upper lip is slightly enhanced with a filler and the upper lip is then laser resurfaced at a depth of 50 – 100 microns.
Vitamin E, coconut oil and almond oil absorb easily and give your skin much needed moisture. Sun protection with lipsticks and balms that contain sun protection factors and hydrate the lips works from both the outside and inside. Such superficial skin exfoliation done tens of thousands of time over one’s lifetime will help lessen wrinkling also.
Take a look at African-Americans and people of Middle Eastern Descent, you rarely ever see them develop wrinkling of the lips. Laser resurfacing with lip augmentation with an injectable filler is the most common method by which I treat more significant lip wrinkling issues. So, in many ways, this is a more significant problem in fair-skinned people of northern European descent, particularly in blondes and redheads. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. By cutting deep laser holes in just a fraction of the skin surface (22% or less), better collagen production and skin tightening is achieved.
There is also the option of a lip lift or lip advancement which provides a permanent change in the vertical size of the lip vermilion and cuts out some lower lip lines as well.
This is probably the best combination if, again, the patient can accept a larger upper lip.
This is done in the office under local anesthesia unless the patient is having other facial procedures which requires a trip to the operating room with the use of deeper anesthesia.
Whether this is better than fillers or laser resurfacing remains to be seen, but I will be able to have a better idea in another year or so after treating and following some patients.
He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.
When combined with an initial very superficial ablative laser pass (< than 50 microns), significant and sustained lip line reduction can be achieved. Do you find you have to keep re-applying it over and over because your lips keep getting drier and drier after each use?
But when lip lines do occur, they can be substantially reduced by injectable fillers, fractional laser resurfacing or even dermabrasion if severe enough. There is some current debate between the laser techniques of resurfacing or peeling and the use of fractional (fraxel) laser treatments, but there is no hard clinical evidence at this point to say conclusively that fractional laser treatments are better. As this heals it causes the skin to thicken which helps reduce the amount of visible wrinkling. Patients will usually have to repeat the procedure once a year for maintenance of good results.
In the more severe cases, a small amount of Botox to help reduce the amount of muscle movement can also be helpful when done with fillers or laser resurfacing but you must be careful to not use to much lest you make your smile have an unnatural appearance. This type of lip moisturizer can help you get off the lip balm roller coaster and help reduce lip wrinkles and prevent your lip stick from bleeding. If you need a fresh new look, consider trying creamier, hydrating lipsticks or even colored lip gloss. Well-hydrated lips may start from the inside, but you should also keep an eye on the product you put on the outside.



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