- Best ResultsImmediate to months
- Treatment Recovery0-12 days
- Procedure TimeVariable
- Skin SpecialistDr Davin Lim
- Duration of ResultsYears
- AnaestheticNumbing- sedation
- Back to Work1-8 days
Wrinkles Perioral / Mouth
Perioral wrinkles describe wrinkles around the mouth. These wrinkles are also known as smoker’s lines. This page will focus on both upper and lower lip wrinkles & the concept of structural support for mature lips. Perioral wrinkling has a complex treatment algorithm, hopefully this will give you some insights into treatment options (that work and look natural).
FactsFacts on Perioral Wrinkle Treatments
- Wrinkles occur in the late 30s & worsen with time
- Upper lip wrinkles are due to both muscle movement & loss of elasticity
- Movement induced lines can be softened with injectables
- Lines at rest can be treated with lasers, micro needling & dermal fillers
- Structural support to the lip is essential in mature women
- Natural outcomes are achieved if the causes of wrinkles are addressed
- Prevention can be achieved with retinol, antioxidants & AHA serums
What are the two types of wrinkles in the mouth area?
The two different types of wrinkling are-
Static wrinkles: are present at rest, mostly due to smoking & sun damage.
Dynamic wrinkles: are made worse with animation; think puckering.
Most patients will have a combination of dynamic & static wrinkling, hence in most cases the ideal treatment involves lasers & injectables.
Why do women have wrinkles & blokes do not?
Five reasons, & they are-
- Men have facial hair; this acts as pylons of structural support in the dermis
- The dermis in males is thicker than females
- Facial hair protects from UV
- Shaving is a form of collagen stimulation, akin to dermaplaning
- Mimetic anatomy is different, females express more, talk more. Sorry.
What types of lasers do I use to treat perioral wrinkles?
Depending on the depth of static wrinkles, I use the following lasers.
- Fractional CO2 & thulium lasers: for superficial wrinkling & mild sun damage.
- Ablative Erbium & CO2 lasers; for deep wrinkling & smokers’ lines.
One session will give great results. If you have higher expectations, a second laser session is possible. Recovery ranges from 4-10 days.
Is laser resurfacing painful?
No. We use anaesthetic blocks & mild sedation to ensure comfort levels. Recovery following resurfacing is painless.
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Is it advisable to treat the surrounding skin?
I do treat the surrounding areas with lasers. This gives a nice blend, reduces demarcation & hypopigmentation. The surrounding areas heal faster than the mouth area.
My usual practice is to use a fractional laser for blending, whilst I employ fully ablative erbium & CO2 lasers for deeper wrinkles around the mouth.
Can chemical peels treat perioral wrinkles?
Medium to deep peels can make a huge difference to perioral lines, including smoker’s lines. I employ Jessner TCA or regional phenol croton oil peels. Peels give less demarcation compared to deep CO2 fully ablative laser resurfacing. Downtime is approximately 7-10 days.
In some cases, I combine peels with fractional ablative lasers, for better results. This only extends the downtime by 24 to 48 hours
How should you approach dynamic wrinkles?
Dynamic wrinkles are due to repeated muscle movement. Take some paper, keep folding it in one direction, notice the lines?
The same thing happens to the lips-especially upper lip. In some cases of hyperactivity we may combine lasers with injectables to help reduce movements.
Can dermal fillers reduce perioral wrinkles?
Dermal fillers can support the upper, lower & corner of your lips, in turn reducing wrinkles. I use both hyaluronic acid fillers & collagen stimulating calcium hydroxyapatite.
Fillers can directly fill the gaps or barcode lines, or they can be delivered to improve structural integrity. Fillers last between 9 to 18 months.
Ideally fillers are synergistic with laser resurfacing as both can increase collagen. Not all lips are suitable for dermal fillers as the aesthetics need to be respected. Patients with a tall or long upper lip to nose ratio are best treated with surgery & lasers. Fillers can exaggerate this ratio.
Can PDO threads be useful?
PDO threads in combination with lasers, can yield excellent results. This type of threading is called monofilament treading. Treatments are comfortable, with minimal downtime. Threads last between 6 to 12 months.
Threads can provide some degree of structural support as they increase collagen production via a process called fibrosis. Lasers & energy devices can compound collagen remodelling induced by threading.
Can microneedling help perioral - mouth wrinkles?
Microneedling can be effective, but the downside is that it requires 3-9 sessions over a span of a year (Has anyone got that amount of free time? Seriously).
Adding controlled heating via radiofrequency can half the number of sessions required. Devices include Infini RFM, Genius RF, Morpheus 8, Intracel, Intensif & Secret RF. Personally, I think lasers are much more effective, however if you want RF microneedling, suggest this treatment during your consultation.
What are crap treatments for perioral / mouth wrinkles?
The three worse treatments include-
- PRP, for dermatologists who don’t know how to use fillers. PRP is good for hair loss, but it does not work in the context of predictable results. It is an unnecessary add on.
- Plasma pen; a sure way of developing lifelong scars.
- LED lights for phototherapy, as seen in many beauty clinics. LEDs feel nice, that is about it. Total waste of time & money in the context of treating perioral wrinkles.
When is surgery indicated?
Surgery is useful in changing the upper lip to nose distance. Over time this distance increases as the lips migrate downward. Lip lift surgery corrects this distance, restoring a more pleasing ratio. In most cases I perform laser surgery on the same day. This generates collagen, further compounding the effects.
Recovery following surgery matches downtime from surgery, namely 7 to 9 days.
What anti-wrinkle creams are best in this area?
After sunscreen, your second layer of defence are antioxidants. These include ascorbic acid, tocopherol, silymarin, & ferulic acid.
To build collagen, retinoids including retinol, retinaldehyde & retinoic acid should be applied nightly, as tolerated. In general, the perioral area is more resilient compared to around the eyes, so irritation is less likely with powerful actives.
For advanced users of skin care, AHAs such as glycolic, lactic, & mandelic acid can be used as tolerated. My clinical team will discuss skin care with you post procedure & how to time the introduction of various ingredients.
What does a perioral wrinkle treatment program look like?
The program depends on the amount of wrinkling & contribution from muscles.
- Mild To Moderate Perioral Wrinkles
Treat with: Thulium or Co2 laser, +/- Botox or Fillers
Maintain with: Retinoic acid & AHAs
- Moderate to Severe Perioral Wrinkles
Treat with: Fully ablative CO2 laser, +/- collagen stimulating dermal fillers
Maintain with: Retinoic acid & AHAs, 1927 Clear & Brilliant Lasers.
Davin’s Viewpoint on treating Perioral Wrinkles
This ranks in the top 3 requested rejuvenation sites for women over 40 years of age. To treat perioral wrinkles well one needs to master dermal fillers, injectables, surgery & lasers. If you have a hammer, everything looks like a nail.
When I am rejuvenating the perioral area, I take into consideration factors such as the degree of solar damage or elastosis, the proportion of static vs dynamic wrinkling, the volume of the upper & lower lip, structural support of the entire perioral area (including the dentition & the skin quality of the adjacent areas), the ratio of the height of the upper lip to nose as well as the distance between the nasal alar & philtrum prominence & height. It is a complex algorithm that requires careful consideration. It is far more complex than ‘I am going to use a laser to resurface skin.’
To markedly simplify things, I have divided mouth wrinkles into static & dynamic, however in all cases, both factors come into play. It is finding the treatment/s of choice that will give the best result for an individual. In most cases it is a combination of modalities that gives optimal results. The hardest concept to get across to patients is that mimetic muscle movements & articulation plays a role in all cases. An analogy is folding a piece of paper. The more you fold it, the more prominent the crease line. Look in the mirror to see if this applies to you when you talk/drink/purse your lips.
For the dynamic element of wrinkling, the use of very small units of muscle relaxing injections can give a good outcome for most. When I mean ‘small units’ it means around 4 units- a fraction of what is needed to reduce frown lines. Tox to the lip is not without side effects (I have had it before for a gummy smile), you can expect some transient weakness of this area until you recruit muscles.
The hardest type of perioral wrinkles to correct is in the aging or mature lip. This requires all skill sets to be employed, including surgical, fillers, lasers, & injectables. Structural support needs to be carefully assessed (including dentition). When I mention dermal fillers in this age group, most women think of duck lips. This is far from the truth. Volume correction is the lips themselves is the last area I look at. I am thinking about structural support of the perioral area. This includes the marionette lines, jowls, pre-jowl sulcus, as well as adjacent areas including the nasolabial folds, & chin-jawline. In the mature age group, you need to balance out these areas, it is not about local rejuvenation- it is more about global aesthetics. Resurfacing the upper smoker’s lines will give good outcomes for that area, but don’t forget that rejuvenation is about the big picture.
Anti-wrinkle creams for perioral rejuvenation? You can buy the most expensive creams & they won’t give any results. Creams are best used to maintain the results following procedures. They include retinol, retinoids as well as antioxidants & alpha hydroxy acids. Do not overdo it in this area, or you will develop perioral dermatitis.
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