Lips and Lines
I've previously written about lip enhancement, and still feel that artificial fill substances such as Restylane, Perlane and Juvaderm are excellent products when placed in the proper location in the pink of the upper and lower lip, and along the junction of the lip and adjacent skin. The lip augmentation treatment with fillers can make thin lips appear fuller for anywhere from a few months to two years.
Another aesthetic problem that develops around the mouth is deep lines that typically appear on the upper lip, and can also affect the lower lips. These wrinkles are often referred to as "smoker's lines" and are caused by the recurrent pursing of the lips that occurs when people take a puff on their cigarettes. However, I often see these lines on women who have never smoked. Hereditary factors, a history of sun exposure, and facial animation such as grimacing, and lip pursing can also play a major role in the development of these wrinkles.
In my practice treatment of these lines has come full circle. When I first started practice 15 years ago, the only real tool we had to reduce the appearance of smoker's lines was dermabrasion or sanding of the skin with a high speed burr. Obviously, this takes a certain amount of skill, so as not to go too deep and cause permanent scarring.
When collagen became available, and subsequently other forms of more permanent fillers, I tried these to fill the grooves, but due to the dynamic action of the underlying orbicularis oris muscle, these fillers soon broke down and were lost.
Laser resurfacing of the skin with carbon dioxide lasers, and subsequently Erbium lasers became popular in the late 1990s. The theory was to stimulate contraction of the skin and underlying collagen, but the results were never as good as I saw with dermabrasion, and the healing time and secondary prolonged skin pinkness was much more pronounced.
So, dermabrasion of these lines seems to reign supreme. This procedure can be done under local anesthesia or nerve blocks. The treated area takes about one week to heal, and must be kept lubricated during this period to avoid secondary bleeding and scarring. Patients with a history of cold sores can be treated prophylactically with antiviral medications to try and prevent a secondary outbreak. The area stays pink for about six weeks and the skin is often dry during this period.
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