Explore Plastic Surgery

I read a recent article that reports that drinking directly from water bottles can cause just as many upper lip wrinkles as smoking. I wouldn’t doubt it as any activity that makes your lips pucker, which activates the orbicularis oris muscle which encircles the mouth, can cause wrinkles to appear on the upper lip. The development of such wrinkles is a function of both the activity and how often it is done. Drinking water these days for some people is about as frequent as a regular smoker who does one or two packs per day.
As a general principle, wrinkles form on the face perpendicular to the direction of action of the underlying muscle movement. For example, horizontal forehead wrinkles are the result of ther vertically-oriented and moving frontalis muscle which extends from the brows upward into the scalp. Since the mouth’s main muscle (like the eyes) is a sphincter or encircling muscle which lies parallel (horizontal) to the upper and lower lip (except at the corners), it is no surprise that the lips (particularly the upper) develops vertical wrinkles in some people. The other factor that highly contributes to lip wrinkles is the thickness of your skin and the size of your lips. (which is interrelated) The thicker your skin, the less likely you will ever develop them. Take a look at African-Americans and people of Middle Eastern Descent, you rarely ever see them develop wrinkling of the lips. (and they have larger lips to begin with….as their skin is thicker)
Treatment of lip wrinkles is a challenging problem. I tell patients to think of it as improvement as there is no complete cure in most cases. For small and fine lines that are mainly located at the junction of the skin and the lip, an injectable filler can make a nice improvement…if you can accept having slightly to substantially larger lips. (whichever you desire) When the lip wrinkles are deeper and run higher into the upper lip, the concept of skin resurfacing comes into play. Usually this means laser resurfacing and it is just a question of how deep to go and how much recovery does the patient want. Laser resurfacing with lip augmentation with an injectable filler is the most common method by which I treat more significant lip wrinkling issues. This is done in the office under local anesthesia unless the patient is having other facial procedures which requires a trip to the operating room with the use of deeper anesthesia. There is some current debate between the laser techniques of resurfacing or peeling and the use of fractional (fraxel) laser treatments, but there is no hard clinical evidence at this point to say conclusively that fractional laser treatments are better. In the more severe cases, a small amount of Botox to help reduce the amount of muscle movement can also be helpful when done with fillers or laser resurfacing but you must be careful to not use to much lest you make your smile have an unnatural appearance.
Other methods of upper lip resurfacing for lip wrinkles is currently being evaluated. One method is to combine laser resurfacing with the use of sandpaper (yes I said sandpaper), known as laserbrasion. With this technique, the laser is only used for the first pass (to remove the very top layer of skin) and the deeper layers are then taken done by fine sandpaper. The concept here is that the use of sandpaper causes less trauma (no heat) and will heal faster without the prolonged redness. And it is just as effective as the laser but safer and with less complications than if one used traditional dermabrasion. The other method is known as percutaneous collagen induction therapy. (PCIT) Known aerating your lawn, a small wheel with fine needles is run over the upper lip, cutting many fine holes into the deeper portions of the skin. As this heals it causes the skin to thicken which helps reduce the amount of visible wrinkling.
Upper lip wrinkles in some women are unavoidable and can be very troubling. Injectable lip fillers, laser resurfacing, abd Botox can help but there is no permanent cure. The alternative treatments of fractional laser treatments, laserbrasion, and collagen induction therapy are interesting but it is too early to know if they will offer better results.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com/
http://www.ologyspa.com/
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

WHAT NEW IN MEDICAL SKIN CARE: Fractional Laser Resurfacing

I frequently get asked what is the new in the world of medical skin care by my patients as well as others. As I think back over 2007, I have put into my practice the following anti-aging medical treatments which I feel are quite promising.

The removal of an outer facal skin layer to improve its tecture is a concept that has been around for decades. Historically, this has included chemical peels and, in the past decade, laser resurfacing. Laser resurfacing essentially ‘burns’ off a top layer (the depths can be very varied from 6 microns to hundreds of microns) and allows new skin (epithelium) to heal over it, removing some imperfections and improving the texture of the skin. Recovery from laser resurfacing varies by the depth to which it is done, a 10 micron laser peel may be a few days, a 100 micron laser peel will be 7 to 10 days. The depth issue aside, laser resurfacing always involves some recovery (as it is a burn) and it only treats the outer layers of the skin.

Fractional CO2 laser resurfacing takes a conceptually different approach. Rather than ‘burning’ 100% of the skin’s surface that it hits, it only treats or penetrates a ‘fraction’ of it. For every area treated, it may only actually hit 10 - 20% of the skin area. Hence, a fractional treatment approach. But equally importantly, the laser penetrates much deeper (hundreds of microns) into the skin, actually stimulating the deepest part of the skin layers. (think of it as boring holes much like you do to your lawn to allow nutrients to get ‘to the roots’ so to speak) Because only a fraction of the skin is treated, there is less recovery than with traditional laser resurfacing even though the depth of laser penetration is much deeper. Also because it is fractional, it requires a series of treatment, at least five, to effectively get all of the skin’s surface treated. In theory, there is more of an anti-aging effect (due to the deeper penetration) but less recovery due to less skin being injured at any one time.

Fractional laser resurfacing of facial skin is being currently touted as being better than traditional laser resurfacing. The evidence to support that claim, to date, is still conclusively lacking. Plus, I am not sure how the laser knows during sequential treatments to hit previous skin areas that have yet to be treated. (of course, it cannot know, so some skin areas undoubtably get treated more than once and some probably are missed altogether as we are talking about fractions of millimeters here) For this reason, it probably take 6 or 7 treatments to truly treat all facial skin areas in the laser’s target. Despite these reservations, fractional laser resurfacing remains appealing and more time will tell exactly what its role in medical skin resurfacing actually is.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis