Insights In Ink : Solving Smokers’ Lines

While natural aging plays a part in the formation of lip lines, so do sun damage and cigarette smoke. In fact, these lines are sometimes called smokers' lines.

Words: Ivette Figueroa

Are you familiar with all the deadly signs of aging? You might have heard of crow’s feet and sagging neck skin, but one of the biggest age giveaways is literally right under your nose.

Lipstick lines, smokers’ lines, marionette lines—call them what you will, but lip lines are a cosmetic red flag that brand you as deeply as they are carved into your skin. And while there are tons of products that claim to fill in those crêpe-like wrinkles, these surface solutions are usually not enough to recapture the lips of youth. Luckily, there’s a wide array of cosmetic procedures, from fillers to lasers, which can plump up and smooth out those obstinate creases.

While natural aging plays a part in the formation of these lines, so do sun damage and cigarette smoke. In fact, these lines are sometimes called smokers’ lines because they’re much more common in people who smoke. Not only do the chemicals in cigarettes age you, the repetitive puckering motion of smoking creates folds in the skin that, over time, result in permanent creases and lines. “It’s this repetitive motion of muscular activity that, as we age, starts to change these wrinkles from dynamic lines to static lines,” says Curtis Schalit, D.D.S., a cosmetic surgeon in Daytona Beach, Fla.

When you add the fact that smoking has a drying effect on skin and is known to accelerate volume loss, it’s clear that smoking is a major factor in the formation of lip lines. That’s not to say that nonsmokers are exempt from getting these stubborn vertical markers. “People who drink through straws because they don’t want to mess up their lipstick, drinking from water bottles, sun damage, smoking, talking—basically all the motions in which you purse your lips breaks down the soft tissues around the mouth,” says Melissa Lazarus, M.D., a dermatologist in Bay Harbor Islands, Fla.

Even lip licking results in a slow breakdown of your lips over time. Known as lip licking lines, these wrinkles are a result of the enzymes found in your saliva. “The first step in digestion begins in your mouth—these enzymes break down soft tissue,” says Dr. Lazarus.

None of this is helped by aging of course, another major culprit causing smokers’ lines. As you get older, your face loses collagen and elastin—the components of skin that give it a full and smooth appearance—as well as facial fat, which accounts for some of your lips’ plumpness. “Volume loss [causes] the skin to bunch and gather around the lines,” says Dr. Schalit. Lip lines, as well as other facial lines and wrinkles, become more and more visible as these components are lost.

Fill Between the Lines

Fortunately, there are solutions. One way to reduce or eliminate vertical lip lines is to replace some of the volume that has been lost. The goal is to replace what Mother Nature gave and Father Time took. Cosmetic fillers can be injected into and around the lips to re-volumize the skin and plump up the lips. “I tend to use Juvéderm for the lips and nasiolobial folds,” says Dr. Schalit. “And Radiesse for marionette lines.” Another option to reduce lip lines is to inject fat from another part of your body into your lips. “Fat transfers can have nice results as well,” says Dr. Schalit. “The big thing for me is downtime, though. With fillers there is little downtime, but fat transfers have a lot longer downtime.” Fat transfers are also less predictable in their results, say some cosmetic surgeons.

Beyond removing smokers’ lines, re-volumizing can also have a positive result for the lips themselves. “As we age, the lips turn in. The part of the mouth that was once on the outside ends up on the inside,” says Dr. Lazarus. “Using a little bit of filler along the border of the very top part of the lip not only helps eliminate vertical lines, it helps pull the lips forward. It’s not something that makes your lips bigger, but something that puts that bridge back.” Of course, care should be taken not to overfill. “If you do the filler wrong, you could end up making your patient look like a duck. Less is more when it comes to that,” says Dr. Lazarus.

Because lip lines are related to the facial muscles that you use to purse your lips, Botox or Dysport injections can be used alone or along with injectable fillers to smooth lip lines. “Using Botox around the mouth helps make the muscles a little weaker and has even been used to help people quit smoking since they can’t purse their lips to smoke,” she says.

Cosmetic Combo

Laser resurfacing treatments can also tighten skin and erase vertical lip lines, and can be done alone or in combination with injectable fillers. This procedure stimulates collagen production and rejuvenates the skin by burning or ‘ablating’ the skin, which re-grows smooth.

Patients can choose between an aggressive full ablation such as Lutronic’s Action II platform, which takes several weeks to recover from but is highly effective, or a fractional ablation such as Alma Lasers’ Pixel CO2 system, which is far less aggressive and takes less than a week for recovery, but requires three to five treatments for the desired results. In either case, the effects can last for more than a year.

There is some discomfort during the laser treatments, says Dr. Schalit, even though a numbing gel is used, and there is some risk of hyperpigmentation. Redness, swelling and some blistering can occur as well, says Dr. Schalit, and “some patients stay pink for six to eight weeks after surgery.”

But the benefits of lasers, says Dr. Schalit, outstrip any other method. Since they address the deeper lines that are etched around the mouth and also even out the patient’s skin tone, laser resurfacing is often the go-to procedure. “Trying to treat with just fillers alone will [sometimes] leave people unsatisfied,” he says.

In the end, a combination of modalities might be the best solution to smoker’s lines. “It all depends on how extreme the lines are,” says Dr. Lazarus. “Often times I do a combination of all three (fillers, Botox and lasers).” Another good solution? Use a good sun block and give up smoking!