Upper Lip Lines – A Not So Simple Problem
One of the seemingly ‘simple’ but most difficult cosmetic facial problems that I see in my practice is the woman with upper lip lines. Like dark spots on the hands, these telltale signs of aging are very disturbing for the aging woman. Ironically, I have seen them even in some younger patients, so it is not always a sign of aging! While frequently thought of as being due to smoking or excessive sun exposure (and these certainly are important contributing factors), it is as much due to the native thickness of one’s skin (racial type) as well as how one moves their face with expressions than anything else. These can be easily shown by looking at African-Americans, Hispanics, and people of Middle Eastern or Pacific Rim descent who have much thicker skin (more dermis and elastin fibers), it is very rare to ever seen upper lip lines in these ethnicities. So, in many ways, this is a more significant problem in fair-skinned people of northern European descent, particularly in blondes and redheads.
The two basic treatment approaches are injectable fillers (JuvaDerm or Radiesse) placed directly into the vertical lip lines or laser skin resurfacing. Often I will do both together, at the same time, to get the best result. These are simple office procedures that are done under a local anesthetic to numb the whole upper lip through traditional dental block techniques. Neither of these approaches ‘cures’ the problem, but significant improvements can be obtained. To maintain the result, it is usually necessary to have the treatments twice a year.
An interesting ‘new’ treatment approach is that of medical needling. This is actually an old technique that may be coming back into popularity. Essentially, a roller with many fine needles is run over the upper lip (like aerating your lawn), creating fine tunnels into the deep part of the skin. Topical vitamin C preparations are then applied after so that they may ‘soak’ into the tunnels and stimulate the underside of the skin, causing it to thicken. So rather than burning the top layer of skin off (laser resurfacing) to soften the wrinkles, this approach focuses on stimulating the skin to thicken. It is being called Transdermal Collagen Stimulation therapy. Whether this is better than fillers or laser resurfacing remains to be seen, but I will be able to have a better idea in another year or so after treating and following some patients.
Dr Barry Eppley
Indianapolis, Indiana