Wrinkles Around The Mouth

What causes wrinkles around the mouth? What are marionette lines and lip wrinkle treatment options?

This post is about what causes wrinkles around the mouth.

Wrinkles Around The Mouth

This is not medical advice. Always talk with your own healthcare provider and medical provider for any cosmetic treatment and medical treatments.

What causes marionette lines and mouth wrinkles? And what are solutions for best treatments or what can you do to minimize the appearance of those wrinkles around the mouth for more youthful appearance?

Some people will call these lines smoker’s lines or lines like marionette string puppets. People will notice that they’re having their lipstick not stay on their lines as much, but some little lines that form around the upper lip as lines around the mouth.

We have changes that go on over time that happen all over the face.  Those changes also happen to that upper lip area, differences in bone, differences in muscle differences in subcutaneous fat, and then also differences in our skin. There are lines that can happen by the side lines that can happen a little bit lower beneath the lower lip, but we will focus on these lines that happen on the top lip.

Lines Around Mouth

There are four main reasons that we have lines that form on that upper lip over time.

1) Bone

2) Muscle

3) Subcutaneous fat in skin

4) Changes that are happening there really cause us to see those vertical lines.

What do I mean by bony changes? Typically as we age, we will have some bony loss in our face. We have projection in our cheek that projects forward and out as we age. That kind of tends to recess back just a little bit.

The same thing happens around our opening for our nose. We refer to that there’s kind of like a little triangle we refer to as a pyriform aperture that tends to get a little bit wider as we age. And the bone around that tends to thin out a little bit.

As we age, we have less support around the corners of our nose. We tend to start to see that nasolabial folds, kind of deepen just a little bit over time. This is one of the reasons for that to happen. And then we also have a little bit less support.

From the bone that’s above our, our teeth change size and projection just a little bit because of their association with the bone and then just life. And so we have less bony support.

And also for some people who have maybe had some dental loss or dental work done over time, that may change the bony support that’s going underneath that top lip.

Think of it like that is your foundation for your house. If you’ve got some shifting that goes on in the foundation of your house, it’s going to affect everything else that’s over top of it.

The same thing, the same principle is assigned there that if we get some changes in the bony support underneath. That’s going to change what we see on top.

Lip Wrinkles

Another thing to be aware of is that we have changes in the subcutaneous and deep fat pad layers of our face everywhere as we go through life.  Typically those fat pad layers become thinner over time and we lose some volume.

And the same thing happens in the top lip. Those fat pads that we have right underneath the skin and underneath the muscle tend to get a little bit thinner over time. And so when that happens, we lose a little bit of just that fluff to that area.

We start to see the muscle movement a little bit more just for you to visualize.

Visualize a layer cake for me. Start with the icing.

If the icing is on the top, like your skin, so that’s our top layer of skin.

The next layer right underneath the icing, we have a little bit of a fat pad layer.

That’s our layer cake, a little bit of a fat pad layer, that’s our subcutaneous fat.

Beneath that, we have something called the SMAS. That is our superficial muscular aponeurotic system that contains our muscles, vessels, nerves most of the time. And that is where we see that muscle movement and muscle pull. From underneath that we have another layer. So we’ve had skin on the top is our icing.

Subcutaneous fat is our first layer. Our mass is our middle layer, and then the bottom layer to that is another layer of fat that we have. Everyone has that in their face.

And then we’ll have kind of bony support underneath that. So that’s our layer cake.

There’s our cake stand, our bone. Then we have our layers going on top of that.

That’s superficial.  That deep fat pad layer tend to get a little bit thinner. And then we have our muscle layer.

Our muscle layer connects to our skin and pulls on it as our muscle contracts. And so over time, if we have less padding between the muscle layer and the skin.

Wrinkles Around Lips

We’ve got that muscle layer pulling over time. We are going to start to see where that muscle is pulling. We appreciate that when we look in the mirror by seeing those vertical lines above our lip.

Now the more we move that muscle layer, we are reinforcing those muscle movements. With smoking, but not only smoking, drinking from a straw, eating, talking, laughing, doing life.

The more we move our mouth around, we are reinforcing those appearance of wrinkles on the surface of the skin.

And then also, and lastly, important to know is that as time goes on, we have changes in the quality of our skin.

Typically that is in the reduction of collagen production that we have in our surface of our skin, making it just a little less resilient. With less collagen, skin is just not as robust on the surface. That leads us to appreciate those deep lines a little bit more.

Some people will undergo a process of something called glycation, which actually makes that skin look a little extra bumpy or a little extra rough on the surface of their lip.

And when we see that there are additional steps or additional treatments that we can do to help reduce the appearance of those fine lines.

Lip Wrinkle Treatment

If you’re starting to see some of those fine lines, what are the things that you can do to treat that? And so if there are four things that are causing those fine lines to form above your lip, that means that there’s more than one answer in terms of your treatment.

Let’s ask that muscle to not pull so hard on the skin. The place we start with a lot of patients is using a little bit of Botox in that upper lip.  We do that to help to treat that muscle called the orbicularis oris that goes around the mouth. That will help the muscle to just not pull so hard on the skin. And then we don’t see those vertical lines quite as much. That is a great place to start.

Patients can try that out to see how effective it is.

We also know that that Botox treatment in that top lip is going to last about six to eight weeks. If for some reason a patient does not like the feeling of that Botox, it will wear off and it’s not a permanent change.

Botox injections is a great place to just start with a treatment plan to see how effective it can be. We can also see if that is giving a patient enough result or if there’s something that they want to do more.

If we want to do more, here are the things that we would recommend.

1) Recommend considering a little filler.

Again, judicious use of our hyaluronic acid fillers in areas that can help provide support. So help really make that cake stand or our bony foundation a little bit more supported so that we have better support for the tissue of the upper lip is a good strategy. Sometimes a little bit of a really thin, thin, thin filler can be used either underneath. So in that top layer of our cake, that subcutaneous layer of fat, we can use a little dermal filler in that area to help hold up some of those lines and support them from underneath. And sometimes we can use teeny tiny micro droplets of filler placed directly in those vertical lines to help reduce their appearance. Think of that as airbrushing. It’s going to reduce the appearance of those fine lines, but it’s not going to make it go completely away.

As a patient, your expectation has to be improvement, but maybe not necessarily making those lines go completely away.

2) CO2 Laser or Fractional Resurfacing

Other things that can help make a change as well is that we can use something called a CO2 laser or we can use fractional resurfacing.

Our CO2 laser and our laser that we have here called the Ultra. Also Moxi laser would be really good, but CO2 laser especially can really help to improve the overall quality of the skin around that peri oral area around that lip area.

And that’s really now treating that skin, asking for collagen induction therapy, really doing some refinement in the surface of the skin and can really make a big impact in that area.

Because our origin of our lines around our mouth is multifactorial, sometimes our treatment also should be multi-pronged.

If you just rely on one treatment alone, whether it’s only Botox or only filler, which we don’t recommend because you can end up kind of looking like you have a thick or almost like a mustache in that top lip by overusing filler in that area.

By using multiple tools in the toolbox, you can get a beautiful result.

Best Treatment For Wrinkles Above Lips

And those tools, again, might be using a little bit of Botox, using a little bit of filler to treat the lines of the upper lip. And then also considering a laser treatment, whether that is a fractional ablative or fractional non-ablative laser resurfacing using a CO2 laser using something like Ultra Moxi are all things that would be the best way to help to improve the quality of the skin of the upper lip and more youthful-looking appearance.

People often ask us about prevention. What can I do for best results?

There are a number of products that are available out there in terms of straws that have maybe a wider mouth opening around them so that you don’t have to purse quite so much when you drink. We don’t know that there are actually good clinical studies that support the use of those scientifically. But, if it makes you feel better to use a wider straw, then that’s one thing you shouldn’t stop yourself from doing if that’s a feel good product for you.

Otherwise, life is going to happen. Enjoy your life, smile, kiss, pucker, laugh, do all the things and just know that we have some solutions for you if that’s an area of concern for you.

If you are a smoker, let’s have a conversation and let’s get you help to quit smoking. One thing that you can do for your health that is more impactful than anything else is quitting or decreasing the amount that you’re smoking that can just dramatically change your life and lifestyle habits.

That even if you are not a smoker, you can get those ‘smokers lines’. People call them smoking lines and they come in and say, but I’ve never smoked a day in my life. You have them because you are living.  You have them because you have spent your life doing happy things like smiling, laughing, eating and sharing meals with people. And those are just part of life, lifestyle choices and lifestyle factors.

We can help you with them if they bother you as a great option.

We can also discuss skincare routine, sun protection for skin health and skincare products to incorporate into healthy habits as well.

Remember, Dr. Nieman is a physician, but may not be your physician. These are strategies we employ Blossom Medical. Obviously, have a discussion with your healthcare provider and see which of those procedures might be a benefit for you.