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Oleh Slupchynskyj, MD, Board Certified Facial Plastic Surgeon
Smokers' Lines and Lip Rejuvenation photo.
"How can I get rid of these lines over my mouth?" I frequently hear this question from my patients who are noticing what are commonly referred to as "smokers' lines". These are vertical lines that appear just above the mouth and actually occur in nonsmokers as well. Created by the muscle actions of the orbicularis oris muscle around the mouth, these lines occur after years of normal mouth movement. Over time, there is a loss of collagen within the epidermal and dermal layers of the skin, resulting in skin laxity, creases and lines.
Typically, these stubborn lines are treated in a few different ways. Phenol peels are a deep level chemical peel that penetrates through the epidermis to the upper layer of the dermis. When the phenol reaches the upper level of the dermis, the collagen becomes disturbed. This disturbance results in the reorganization and development of new collagen. New collagen leads to more fullness and therefore fewer lines. One possible drawback though is hypo-pigmentation, or a permanent loss of color of the skin around the mouth. While effective in treating smokers' lines, this potential side effect may be enough to deter some patients from phenol peels.
Smokers' lines can also be treated with dermabrasion. Not to be confused with micro-dermabrasion, dermabrasion involves the sanding down of the top layer of the epidermis through to the upper layer of the dermis. While the method of disturbance is different, the principle is the same: disruption of the collagen in the upper dermal layer, this time by dermabrasion, allows for the reorganization and creation of new collagen. One possible downside to this treatment is redness over the area that can sometimes persist for weeks or months. If not done properly, it can also lead to scar formation.
In the 1980's and 1990's laser treatments were developed and also used to treat smokers' lines. However, laser treatments have similar drawbacks to the phenol peel and dermabrasion. Scar formation, hypo-pigmentation and hyper-pigmentation (a darkening of skin color) are all possible. Lasers are also less cost-effective, as machines and equipment are very expensive for the physician, and that cost is often passed on to the patient.
As you can see, smokers' lines, unlike other facial wrinkles, present a bit of difficulty for the practitioner seeking to treat them. There is a high level of technical know-how required for all of the methods described above, so many times practitioners take the easier path and treat smokers' lines with Botox, fillers and softer, less powerful lasers. While these treatments may produce small results, they are mostly ineffective. Penetrating the upper level of the dermal layer is necessary in order to see real results.
So, what do I tell the patient who hates the lines above their mouth? My preferred method of treatment is dermabrasion. Dermabrasion can be performed under local anesthesia and with very little downtime. I achieve consistent results with this method and think it's the best way to say goodbye to your smokers' lines. See the Before and After Photo of one of my patients who had dermabrasion to her mouth and chin area.
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