Did your  mother ever tell you, "If you keep making that face, its going to s tay that w ay", like mine?  Little did I know then that this would turn out to be yet another of  tho se Mom-statements that I didn't believe but pr oved to be true.

A family photo from 1966 with Dr. Elliott on the bottom left, and Dr. Elliott's mother looking down, thinking (for many reasons), "She's going to be sorry"

Closeup of the expression (and bangs)

Wrinkles around the lips, sometimes called "smokers' lines", are caused by repetitive mouth  movements, like those used when drinking through a straw or smoking, along with the structural changes in the face that develop with aging.  

Like a piece of paper that's been folded over and over until the crease remains visible even when the paper is flat, after years of repetitive movement, wrinkles develop that become visible even when the muscle is relaxed.

Thick skin resists creasin g better than thin skin, so thick-skinned people tend to get wrinkles later in life than those of us who are thin-skinned, although everyone experiences thinning skin with aging.

So what's the more important cause of smokers' lines - skin thickness or muscle movement? Hint: men don't get smokers' lines even though some of them talk so much.

Other depres sing physical changes that occur with aging around the mouth and contribute to the development of smokers' lines, include a decrease in bone, fat, skin elasticity , oil glands and collagen. The bones underlying the nose and teeth resorb, fat compartments shrink and t here's atrophy of the underlying muscles and ligaments. Losing teeth causes even faster bone resorption and accelerates the aging changes.

With less suppo rt, elasticity and skin thickness, the upper lip flattens and turns inward. In profil e, t he elderly mouth appears to  fall backwards. That's me on the right.

Recommended Treatments for Perioral Wrinkles (Smokers' Lines)

My recommended treatments for smokers' lines depends on  the depth of the lines as well as the quality and  thickness of the skin around t he li ps.

If the lines are only visible when the lips are pursed, injected  muscle relaxants like Botox or Dysport can be used, like in other areas of skin creasing due to muscle contraction (examples: crow's feet, frown and forehead lines), to decrease the degree of creasing of the skin. This can prevent the formation of wrinkles when relaxed.

Someone with thic k skin & a few deep lines benefits most from a dermal filler to lift the individual lines. The filler  must be placed precisely in the  plane of skin that will lift the line but not produce a ridge, and our injectors are experts with this treatment.

Someone with thin or aged skin with a lot  of superficial lines, usually does better with ablative laser resurfacing,  and sometimes also a dermal filler to thicken all of th e skin   between the nose & the upper lip.  Like my photo of my mouth after I dissolved the filler on one side, without support below the surface, the skin falls into muscle creases.

An example of thin, aging skin

Ablative laser resurfacing can be done either by removing the full surface of the treated area, which is also referred to as full surface skin resurfacing, or by removing a percentage, which is called fractionated ablative laser resurfacing. 

I've been performing laser resurfacing for over 10 years and have been an instructor for other practitioners learning laser techniques, and experience is very important with a treatment that removes this much skin. Don't risk being scarred by having your laser resurfacing done by a provider who doesn't have years of experience and plenty of their own (not laser company photos) before and after photos.