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I am 44 years old and I just quit smoking, I have the vertical lines above my lips; what should I do?

Plastic Surgeon Dr. Dean Kane of Baltimore Answers Question Regarding Injectables

Q. Which is better? Botox, Restylane,or Juvederm?

A. There are various ways to reduce lines around the mouth and lips. Each depends on the level of the wrinkle deformity, ie., epidermis, dermis, fat, muscle and skin color.

Based on the limited information you have provided, Restylane Silk is the better option filler for the short course. I would recommend:

  1. Consult with a Board Certified Plastic Surgeon with considerable skill and talent in the use of non-surgical and minimally invasive options.
  2. Dysport to relax the lip muscles
  3. Sculptra to build collagen and elastin
  4. ThermiTIGHT to stimulate skin tightening
  5. Obagi ZO Skin Health for exfoliation, stimulation, skin color eveness

The most popular of the fillers, Restylane and Perlane, a jelly-like clear skin filler is used to fill lines, wrinkles and folds. Juvederm and its longer lasting “cousin” Juvederm Ultra Plus are similar skin fillers, used to soften and fill the nasolabial (“parentheses”) and marionette folds, the brow (“number 11”) lines and fill and lift the cheeks and lateral brow or chin. Voluma and Lyft are the longest lasting HA fillers, up to 2 years and 1.5 years duration HA. Each one is used to expand, project or volumize the loss of tissue associated with expression, weathering or aging. All the fillers come with numbing anesthetic!.

Restylane Silk is a wonderful new addition to the filler family. It is thinner and smoothening, particularly for the lines around the mouth and lips. I have also found it useful for the crow’s feet and forehead lines too.

Scuptra is the latest of the injectibles stimulation collagen at different levels of the skin adding volume but primarily firming and adding resistance to the formation of wrinkles, folds and descent.

Botox and Dysport too have been found to rebalance excessive facial expression, provide a non-surgical brow lift and lip lift and reshape the nose, as well as reducing wrinkles even around the mouth! ·

  1. Fillers in the lip like fillers elsewhere require and understanding of the anatomy and injectable results. For example: beyond the white roll, upper and lower lip wrinkles improve with Botox and smoothening fillers such as Silk in the dermisthe white line and philtrum project better with smoothening or volumizing fillers like Silk or Restylanethe lipstick lines of the dry (pink) vermillion are best injected with a volumizing filler like Restylane in the sub-mucosal layerlip fullness is best with projecting to volumizing fillers such as Lyft, Juvederm Ultra Plus along the wet/dry border of the vermillion liplip pout can be improved with filler injections in the buccal mucosa (ie., back of the lip, inside the mouth) allowing the lip to push off the teeth. ·

2. Artistic use of Botox and similar injectable muscle relaxers just outside the upper and lower lip white line will reduce lip creasing and increase the pout of the lip(s) without fillers. ·

Dr. Obagi’s new, second generation ZO Skin Health programs may be added to personalized chemical peels, light and laser resurfacing and tightening and will, smoothen and even the color of your skin. IPL and fractionated lasers such as CO2 and erbium and now RF (radiofrequency) are additions to smooth the texture of the skin, tighten and reduce red and brown uneven pigmentation.

These options may be used similarly around the eyes with the caveat that the Injector must understand the art and science behind the injectables he or she are using and the anatomy and dynamics of facial expression.

All surgical, minimally invasive and non-invasive procedures and their combinations should be discussed following a proper examination with a well versed, Board Certified Plastic Surgeon who performs all of these options so you will not receive a biased approach because he limited in his skills.

I hope this is helpful. All the best!

This information is not meant as medical advice. It is provided solely for education. Our practice would be pleased to discuss your unique circumstances and needs as they relate to these topics.

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