- Dec 01, 2023
How to get rid of vertical lip lines with non-surgical treatments and skincare
AUTHOR - DR. DAVID JACK
Vertical lip lines are a particular bugbear for many of my patients. More common in people who smoke (due to repeated pursing of the lips and enhanced tissue breakdown as a result of tissue damage), they are sometimes referred to as smokers lines or ‘barcode lines’. This being said, many patients who have never smoked do develop these with age - ageing generally affects the mouth area disproportionately compared to the rest of the face.
Why do we get vertical lip lines as we age?
Both intrinsic and extrinsic factors affect how our face ages around our mouth, thinning all of the layers of the skin in this delicate area. Intrinsic ageing (relating to the natural age related cellular changes that are programmed into our cells) operates silently, guiding the natural life cycle of our skin towards a loss of firmness, thickness and elasticity through loss of collagen, elastin and fat tissue. Collagen and elastin wane in production as we age, and this results in thinning of the dermis of the skin particularly in areas where there is tension from muscles pulling on the skin surface.
Extrinsically, environmental factors significantly enhance the appearance of vertical lip lines. Exposure to Ultraviolet (UV) radiation is probably the most important extrinsic factor. UVA and UVB light from the sun (and also sunbeds) cause direct breakdown of collagen and elastin fibres, diminishing the dermis’s supportive matrix and enhancing the appearance of wrinkles. Sun exposure not only accelerates the visible signs of ageing but also inflicts cellular DNA damage, amplifying the risk of irregular pigmentation and compromising the skin’s overall health.
For smokers, collagen and elastin breakdown is even worse. The repetitive pursing of the lips, an action intrinsic to the act of smoking, coupled with the exposure to tobacco smoke, a source of free radicals and oxidative stress, cumulatively intensifies the formation of wrinkles around the mouth. Nicotine constricts blood vessels, impeding oxygen and nutrient delivery to the skin, while the myriad of toxic chemicals in tobacco smoke directly injures the skin’s structural components.
In essence, the formation of these discreet lines is therefore a multi-faceted issue, caused by both our biological makeup and our own lifestyle choices. A multi-dimensional approach in management and prevention, can therefore help prevent and minimise their appearance. In this article I will summarise my approach to these lines, from skincare for lip lines, to more intensive, in clinic treatments for smokers lines around the mouth.
Skincare for smoker’s lines
Skincare is the starting point for treating smoker’s lines, and something that you can start immediately. This requires an integrated approach, leveraging the rejuvenative and protective properties of a select core of ingredients to mitigate the impact of both intrinsic and extrinsic factors.
- VITAMIN C: Vitamin C has potent antioxidant properties so is an important ingredient in treatment and prevention of lip lines. It not only combats oxidative stress but also plays a crucial role in collagen synthesis, supporting the skin’s structural integrity. Vitamin C also acts as a tyrosine inhibitor, so can also help treat any hyperpigmentation that might have developed in the area.
- SUNSCREEN: Most importantly, the vigilant use of sunscreens is fundamental for smoker's lines. Broad-spectrum sunscreens shield the skin from the deleterious effects of UVA and UVB radiation, reducing acceleration of intrinsic ageing processed and safeguarding the skin from further collagen degradation.
- RETINOIDS: Incorporating a retinoid into your skincare routine is also important in treating vertical lip lines. Retinoids, which have been shown to stimulate collagen production and enhance cellular turnover, function to gradually soften lines and enhance skin texture, potentially diminishing the visibility of smoker’s lines over time.
- HYDRATION AND BARRIER REPAIR: Whilst the above actives can help repair and prevent lip lines, to minimise the appearance of smokers lines on the short term, I’d focus on a few key ingredients. Hyaluronic acid is well known for boosting hydration, helping the skin retain moisture and giving a plumped, smoother appearance to fine lines around the mouth. Ceramides help restore and enhance the skin’s natural barrier, keeping moisture in and irritants out, whilst maintaining a healthy microbiome. Peptides can also support collagen production. Using a moisturiser that combines these ingredients can help hydrate and protect the skin in this delicate area
Microneedling for Lip Lines
Microneedling, an increasingly popular skin rejuvenation method, can be an effective and simple approach to treating vertical lip lines. This procedure uses tiny needles to create controlled micro-injuries in the skin. Your skin then responds to these micro-injuries by producing more collagen and elastin, enhancing skin’s elasticity and firmness and minimising the appearance of the lines over time. In addition, the small channels made by microneedling allow for better absorption of skincare products, such as hyaluronic acid or vitamin serums, directly enhancing their efficacy by enabling them to penetrate deeper into the skin. Likewise, post treatment enhancers such as exosomes can further boost the effectiveness of microneedling treatments by enhancing collagen production.
Given the sensitive nature of the perioral region, microneedling must be approached with caution and precision. The depth of needle application and choice of topical products should be tailored to each individual’s skin requirements and responsiveness. Professional guidance is crucial to ensuring the safety and efficacy of these treatments.
Neurotoxins for vertical lip lines
Anti-wrinkle injections, using botulinum toxin, have proven to be useful in treatment of vertical lip lines. These work by temporarily relaxing the orbicularis oris muscle around the mouth, reducing it’s activity and in turn softening the appearance of the lines caused by repeated movements, such as pursing of the lips. Minuscule doses are injected with the aim of diminishing the creasing effect that occurs with muscle contraction during these facial expressions. As the muscle relaxes, the overlying skin smoothens and is able to regenerate without the repeated tension on the dermis, which over time leads to a softening of these lines.
The exact placement and dosage of the injections are paramount to achieve a natural-looking reduction of lines without compromising essential facial movements. While the procedure itself is typically very quick, often completed within a lunch-hour appointment, the results can last for several months before needing to be repeated. Safety and expertise are crucial for treating the delicate perioral area - only ever see an experienced, well qualified practitioner for this advanced treatment.
Dermal Fillers for smokers lines
Dermal fillers are another approach to managing vertical lip lines. Hyaluronic acid fillers such as juvederm act by adding volume to the area, where fat volume has been lost, in turn buttressing the skin from underneath to indirectly minimise and smooth the appearance of deeper lines, without affecting the movement or expression around the area.
The skill of the practitioner plays a pivotal role in ensuring that the fillers are dosed and placed accurately to achieve a result that is both effective and harmonious with the rest of the face. Careful consideration of filler type, injection depth, and technique are vital in the perioral area. My personal favourite for this area is a hybrid product called Teosyal Redensity 1, which has attributes of a skin booster but is a very soft and gentle filler. Usually this would be injected over two sessions (like a skin booster), to ensure a natural and subtle result. Most fillers are non-permanent so need repeated treatments every 6-18 months.
Skin Boosters for lip lines
Skin boosters, such as Profhilo and Polynucleotides, work by improving dermal hydration and stimulating thickening of the dermis of the skin through stimulation of collagen and elastin production. This in turn creates a gentle lifting effect and tightening effect that can reduce the appearance of fine lines and wrinkles around the mouth.
Profhilo, one of the most popular skin boosters in the UK and Europe, consists of a uniquely stabilised and high concentration form of hyaluronic acid, designed to integrate into the dermis of the skin. When it’s injected it can boost hydration, and over time it can lead to enhanced production of dermal collagen and elastin. In this way it is an ideal treatment for fine lines and wrinkles around the mouth as it provides both a short term (hydration) and longer term (collagen and elastin stimulation) effect. Polynucleotides, on the other hand, use fragments of DNA and RNA to biostimulate collagen and elastin production. Both can be injected directly into the area, and both require multiple sessions for best results. A benefit of skin boosters is that the results will always be subtle and they can provide visible improvements without drastically altering volume or contours, thereby maintaining a natural appearance.
Considering the thin and sensitive nature of the skin around the mouth, precise injection technique and product knowledge are crucial to achieving optimal results with minimal adverse effects. Always seek the opinion of an experienced practitioner for any injectable treatment.
Skin Resurfacing for Lip lines
Advanced skin resurfacing techniques like Morpheus8 resurfacing and fractional lasers, are another option for addressing barcode or smoker’s lines. Both treatments work on the principle that the response to a controlled, fractional injury will result in thickening of the dermis layer of the skin, with new collagen and elastin formation, and improvements in the appearance of fine lines and wrinkles in the area around the mouth.
Morpheus8 resurfacing combines a patented form of microneedling with radiofrequency energy, targeting the dermis of the skin - the combination of a thermal injury with a mechanical fractional injury will often give a more potent response than microneedling alone. This treatment can be further enhanced by using exosomes post treatment, which can further boost collagen and elastin production.
Ablative laser resurfacing, with devices such as CO2 laser (for example fraxel) use a high-energy beam of light to fractionally injure the surface of the skin by targeting water molecules in the dermis and epidermis. This in turn stimulates a regenerative response, which in turn promotes healing and minimisation of perioral wrinkles. Plexr plasma pen is another option for resurfacing this area. This technology uses plasma energy to vaporise small cores of tissue on the surface of the skin, again, stimulating a healing process and in turn improving skin quality in the treated area.
With any resurfacing treatment, downtime can be fairly extensive - often resulting in redness and scabbing for a week or so post treatment, and often more than one session will be required.
Effectiveness and safety in these advanced skin resurfacing treatments rely on the skill and experience of the practitioner performing the treatment. These treatments are highly customised to the patient undergoing the treatment so should never be conducted by inexperienced practitioners.
Deep Chemical Peels for lip lines
Mid to Deep chemical peels are another, somewhat more traditional, option for treating lines and wrinkles around the mouth. These work by creating a controlled ‘burn’ in the treated area which in turn initiates a pronounced skin exfoliation and regeneration process that can minimise the appearance of fine lines. Mid to deep peels use potent peeling agents, such as trichloroacetic acid (TCA) or phenol, to selectively injure and subsequently renew the outer layers of the skin. This in turn stimulates the skin’s natural healing mechanisms to replace the removed layers and improve the surface texture of the skin in the treated areas.
While deep chemical peels can offer notable improvements, downtime and healing can be substantial - often involving a week or so of intense peeling, followed by redness, before healing fully. The importance of professional administration cannot be underestimated, so selecting a provider that is highly experienced in the use of deeper peels is essential for managing the post-peel period. Phenol peels, for example, may even require general anaesthetics for application. Given the effectiveness of other treatments such as CO2 laser and Morpheus8 resurfacing, peels have become less popular in recent years.
Summary: The best non-surgical ways to treat vertical lip lines
Vertical lip lines can be effectively treated using a combination of non-surgical treatments. In this article I’ve explored a number of effective options which can help minimise the appearance of lip lines - each with its specific utility and outcome. From dermal fillers to laser resurfacing and deeper chemical peels, several pathways exist, depending on your appetite and availability for downtime. The key to effectively treating this area lies in the hands of your practitioner, who can help you safely tailor these options to your individual aesthetic needs.