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 my patients
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 I'm Dr. Amiya Prasad I'm a Board-certified cosmetic
surgeon and Fellowship-trained oculofacial plastic and reconstructive
surgeon I've been in practice in Manhattan and Long Island for over 20
years I perform treatments for the lips and area around the lips every day 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 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 car
text 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
have 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 as I always say the whole is great in the sum of its parts
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 Alliance 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 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 W-switched laser and a 250 microsecond and Nd:YAG
laser we call laser skin toning I described us 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 used 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 and 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 I
hope you found this information helpful thank you for your question
you