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Dorinda Hallenbeck asks:
I really HATE the vertical lines above my upper lip, and, The deeper lines on either side of my chin.

What is the longest lasting correction with the best results for these problem areas.

I am not a fan of fillers as I feel they really change the natural look of one's face...and Botox is a never ending expense.

Thank you for any suggestions.
dindy904

On: 01/29/2013 01:39 pm

To doctors from: New Jersey

Category: Facial Lines

Answers

DrMarthaMatthews on 02/04/2013 01:21 pm wrote:
Lip lines are caused by repetitive creasing of the skin due to muscle movement. We all do it to some extent, but the habit of pursing the lips in facial expression, or in sucking on a cigarette, can accentuate the problem. In addition, sun damage and heredity play a role. The lines on the sides of the chin are also caused by muscle movement - in this case, the muscles that pull down the lower lip corners. These lines are called “marionette lines” because of the resemblance to a marionette puppet’s mouth.

Wrinkles that are caused by muscle movement can never be entirely erased, unless the muscle no longer moves. Muscle movement in the face is what gives us facial expression. It is also slightly different in every person, and is one of the things that makes our faces unique to us! In addition, around the mouth, muscle movement is important for smiling, eating, and speaking.

Botox works by paralyzing muscle. The muscle doesn't move, therefore the skin doesn't wrinkle. This causes obvious potential problems around the mouth. It is possible to put small amounts of Botox in the lips to weaken the muscle, and to improve the fine vertical lines; however the response is not entirely predictable. Possible side effects include too much weakening, or uneven weakening. This might cause differences in the appearance of your smile, asymmetry of your mouth, or even trouble with puckering up.

Botox can also soften marionette lines, however too much can affect the smile or the ability to move lower the lip.

As you point out, Botox is not permanent, and in these applications around the mouth, will only last a few months. If you choose Botox, make sure you go to a doctor who has experience with using it around the mouth. And, don’t expect miracles.

Fillers plump up the tissue beneath the wrinkles and smooth them. Again, the amount and type of filler is important, as well as the injection technique. Too much around the lips can look artificial.

Perfection is probably an unrealistic goal. Most of my patients really dislike the “ducky” look of fillers in the lip. But I have found that a very small amount of filler just in the white roll (that little pale ridge of skin just above the red lip) will block lipstick bleed into the lines, and gives a very subtle definition. The filler can also be threaded directly into the deeper lines. The correction isn't 100 percent, but looks nice with little downtime.

Heavier fillers or fat generally works best in marionette lines, but again, you can’t go too far. It is not realistic to expect to be completely flat - if you inject that much, it often looks like you just had dental work! If you have skin laxity or jowling, you may benefit from a facelift.

A long lasting option to improve a very weathered, severely wrinkled upper lip skin is skin resurfacing. Results depend on the depth of the resurfacing more than anything else. Laser resurfacing works best, in my opinion, but the downtime is considerable. Plan on looking bad for about a week, and red enough to need makeup to cover for about 1-2 months! Medium depth chemical peels do work, but don’t tend to last as long.
DrBeverlyFriedlander on 01/30/2013 03:21 pm wrote:
Dear Dorinda,
The best treatment for the lip lines and the marionette lines(the lines on the side of the chin) unfortunately are fillers. Belotero Balence the newest of the HA fillers(like Juvaderm and Restylane) offers ecellent correction of more superficial lines because it ie softer and integrates beatifully into the tissue. Radiesse provides the best correction for the chin lines when injected by an experienced physician. The result is completely natural if the product is injected into the proper depth and region.
I hope this helps. Good Luck,

Beverly Friedlander, MD
DrKevinTehrani on 01/29/2013 10:37 pm wrote:
Dear Dorinda,
Fillers and Botox are the answer to your question in the vast majority of patients. The natural look can be achieved and has to do with the method and amount of correct injectable. Having said that you may be a candidate for more natural collagen stimulators like Selphyl (uses your own platelets) or LaViv (uses you own fibroblats grown from your skin).