One of the features of facial aging that bothers women the most is the development of upper lip lines. Whether they be small fine lines that are at the junction of the skin and upper lip or much deeper lines that extend vertically way up into the skin...women hate them...as they indicate a more aged mouth look and in more severe cases allows lipstick to bleed up into the 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.
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. 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.
While the diagnosis of this problem is easy, it's treatment is not. 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. Treatment choices are based on three achievable objectives; diminish the muscle movement (Botox), plump up the lips or fill the lip lines (injectable fillers), or 'sand' down the wrinkles. (dermabrasion or laser resurfacing). Any combination of two or more of these will produce a better result in most patients. 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.
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. Injectable fillers are a good option if the patient can accept or wants a larger lip. If not, then dermabrasion or medium-depth laser resurfacing is the only other option. 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.
This is probably the best combination if, again, the patient can accept a larger upper lip. It heals within a week and can be done in the office under local anesthesia. Patients will usually have to repeat the procedure once a year for maintenance of good results. However, it is fair to say that upper lip lines defy one single permanent solution.
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