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A 20-Year Veteran’s Approach to Lip Wrinkle Treatments

Posted: 6:00 a.m. Sunday, Aug. 27, 2017

By Anita Mandal, M.D.
Question: I had many lines above my upper lip. A plastic surgeon treated me with Restylane. While some of the deeper lines look better, the fine lines are still there. Worst of all, my upper lip skin looks over-plumped and unnatural. How could I have prevented this?

Answer: The routine use of injectable fillers for the treatment of lip lines is an over-simplistic approach. Not all wrinkles and lines are the same. Thus, the treatment for upper lip lines is going to differ in each patient.

The key to the successful treatment of lip wrinkles lies in first identifying the cause and type of wrinkles. Many patients don’t just have one kind of wrinkle, but show multiple types of lip lines, all of which should be addressed.

While deep wrinkles can be treated with injectable fillers such as Restylane or Juvederm Ultra, superficial lines are more amenable to a “surface” line-filler such as Restylane Silk or Bellatero.

A common error occurs when a less experienced injector overlooks overactive lip muscles which often contribute to making lip lines appear worse. An easy test is to purse your lips. If the lines get stronger, then the lip muscles must also be treated in order for filler treatments to be effective. Botox cosmetic, Dysport or Xeomin, injected in very minute doses into the tiny lip muscles of the orbicularis oris, can be very effective when combined with injectable filler treatments. Caution is advised as micro-Botox injections, like any advanced-level aesthetic treatment, should only to be performed by an experienced physician

Another common physician error is to inject lip lines that are so fine that filler treatments result in an over-plumped lip. When filler thickness or injection needle diameter is much greater than the fine line itself, this is a clue to perhaps avoid injecting fillers in those specific wrinkles. “Laser” treatments such as Infini RF can be very beneficial for these type of fine lip lines that are not amenable to injectable treatments.


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