Smoker's Lines (Ep. 52)

All right, welcome back to another episode of the Trillium Show, Dr. Jason Hall. And today we're going to talk about one of my favorite topics and a topic that just frustrates people to no end. And that's the little smokers lines or barcode lines around your upper and lower lips. Now these lines can be some of the most difficult wrinkles to treat on the face and they have frustrated.

A number of patients and a number of doctors, both surgeons and non surgical cosmetic providers who try and get rid of these things or make them better, and they're very, very difficult to treat. And so in this show, what we're going to do is we're going to talk a little bit about what causes those lines, because if you've heard any of my other shows in the past, you know that just like in Real medicine, in cosmetic medicine, in surgery, if you don't get the diagnosis right, and you don't understand what is causing the problem that you're seeing, then you are never going to get the treatment right.

Or if you do, it's just going to be by chance. And so, what I want to do today is go over what causes these lines, and then we'll talk about what the treatments are and why these treatments make sense. If you go back and listen to some of my previous shows, specifically the show on facial aging, you'll know that there are three main components to facial aging that we have to address. And addressing lines around the mouth kind of falls under this same umbrella.

Those three components are skin, volume and then structure. And so we have to address a treatment, just like if we're talking about aging of the lateral face, the jowls, the neck, we have to talk about treating these same areas when we're talking about the lines around the mouth. That's why so many people who I see who have been other places come in and say, well, I got lip filler and the lines are still there.

Well, that's because we're only treating part of the problem. Now these lines are called smoker's lines for a reason because people who constantly purse their lips, so think about sucking on a straw or smoking a cigarette, are going to be constantly wrinkling that skin around the mouth.

The orbicularis muscles, it's a circular muscle around your mouth that lets you move your mouth and talk. Contracts in a circle, and so it makes these little radial lines, the lines that go from your lip up to your nose and kind of out towards your eyes. And over time, you're naturally going to cause wrinkles in the skin just from the contraction of those muscles time after time after time after time.

And so, the muscle activity is primarily responsible for the initial creasing. And to that The chronic damage from a lifetime of sun exposure. Now most of you for my age, and certainly, older than me, sunscreen wasn't a big thing. And if you used it as a kid, it was like an SPF of 2 or an SPF of 4 if you weren't trying to use baby oil or iodine or something to get tan.

And so, that chronic sun damage, Damages the upper and the secondary layers, the dermis of the skin, and causes those creases, which start out as being temporary lines, to become more permanent lines as that skin thins out and changes over time. And so you start getting these lines kind of baked into the skin that occur as a result of natural muscle activity.

This happens everywhere in your face, it happens in your 11 lines, in between your eyes, it happens in your crow's feet, it happens in your forehead. That muscle activity over time causes the skin to wrinkle, skin damage on top of that causes those lines to become permanent, so they're there. Even when you're not moving and if you want a kind of a better discussion of the lines and wrinkles of the face I did a show.

I can't remember what number it is we'll put it in the show notes about the three different kinds of lines and wrinkles and It kind of gives you a primer on What to expect and kind of how the face ages and where some of these lines and wrinkles come from

Now you have an idea of the pathophysiology, where these lines come from. The third part is volume loss. Now, we all lose volume in our face as we age. It doesn't matter what your weight does, although weight fluctuations will make that worse if you're losing weight, or better if you're gaining weight.

But we all will lose facial volume with time. That includes around the mouth. And so, re volumizing the lip, you think about a lip that deflates, you're going to see more creases than a lip that is puffy. And so, adding some volume back to the upper and lower lips will help with some of those smoker lines.

In a lot of cases, they won't make them go away because volume loss isn't the only thing that's causing those lines. It is skin damage and changes in the skin over time which cause those lines to stay there. When we're designing a treatment for smokers lines, a combination of skin treatments and volume restoration really helps.

to improve those lines and make them significantly better. Now, we're never going to make them completely go away. We can't make any line on the face completely go away, but we can make them 70 to 80 percent better with optimizing our treatments. Now, what is an optimal treatment? So, we have to address the skin first, and this is where Laser treatments are a primary form of treatment for these lines, and we have to be aggressive to really make an impact.

Some of your light laser treatments that you might get at a medical spa, we even offer some of those lighter treatments here for different things, really don't give you much of a result. You have to get down, you have to think about polishing. The surface of the skin you have to almost polish those wrinkles out To smooth the surface of the skin To really make a big difference That is not a treatment that you are going to go home the same day and say oh, I'm a little red I think I got my laser treatment it requires days of downtime and recovery But at the same time Your result with a single treatment is pretty awesome.

If you go to my Instagram, go to my website, you can see some results of what we call perioral, or around the mouth laser treatments. Really dramatic improvements with a single laser treatment.

Earlier in the show, I talked about the skin not being the only thing causing those lines. Volume loss is another thing that contributes to those smokers lines being present and permanent. And so restoring volume is the second way that we get an optimal treatment. So it's skin resurfacing and volume restoration.

There are two flavors of volume restoration. There's injectable filler And then there is fat injections. Fat injections being more permanent, filler being more temporary, but there's a little bit of predictability difference between the fat, which is a little bit less predictable, but more permanent, the filler being more permanent.

More predictable, but less permanent. The other thing is that filler, especially up near the surface of the skin, can cause a little bit of bluish discoloration, especially if there's already some discoloration of the upper lip. Filler can make that a little bit worse. And so we want to be careful and really look at your upper lip before we decide what we're going to do to try and fill those areas in.

The other part of filling the lip is that it has to be done tastefully. I think everybody's seen the duck lips, the elongated upper lip from too much filler, where you take a deflated but pretty shape of a lip, and you make it flat and really long where you don't see any of your upper teeth. We don't want to do that.

We want to fill in tastefully. Just what was missing, and then let our resurfacing do the rest. To get back to the very beginning, with Smoker's Lines, just like with any other area of the face or body, and any other area of medicine, we have to get the diagnosis right. We have to know why we're seeing what we're seeing before we can design a treatment plan to address those things. Now, can we do a little bit of volume restoration without doing resurfacing?

You can. Can you do resurfacing without doing volume restoration? You can. You'll get. Some result, it may not be the optimal result, but that's where we kind of sit and talk about what your goals are, where you're starting, and design a treatment plan that's going to fit for you in terms of recovery and budget and all these other considerations that we have to have, but know that aggressive laser treatment really is first line when we're talking about improving those smokers lines.

Volume is another adjunct that we can use to make that result better, but laser for smokers lines and aggressive laser. So a week of recovery time really is the best single treatment to improve these. Thanks for listening. I hope you guys enjoyed this show. As always, if you have any questions, comments,

please DM me on Instagram @drjasonhall or you can send me an email media@drjasonhall.com. And if you have any ideas for other shows, shoot me an email, send me a DM. We'd love to hear from you. Thanks again.