Plastic Surgery Treatments For Lip Wrinkles

I read a recent article that reports that drinking directly from water bottles can cause just as many upper lip wrinkles as smoking. I wouldn't doubt it as any activity that makes your lips pucker, which activates the orbicularis oris muscle which encircles the mouth, can cause wrinkles to appear on the upper lip. The development of such wrinkles is a function of both the activity and how often it is done. Drinking water these days for some people is about as frequent as a regular smoker who does one or two packs per day.

As a general principle, wrinkles form on the face perpendicular to the direction of action of the underlying muscle movement. For example, horizontal forehead wrinkles are the result of their vertically-oriented and moving frontalis muscle which extends from the brows upward into the scalp. Since the mouth's main muscle (like the eyes) is a sphincter or encircling muscle which lies parallel (horizontal) to the upper and lower lip (except at the corners), it is no surprise that the lips (particularly the upper) develops vertical wrinkles in some people. The other factor that highly contributes to lip wrinkles is the thickness of your skin and the size of your lips. (which is interrelated) The thicker your skin, the less likely you will ever develop them. You rarely see lip wrinkles in people with thicker skin such as African-Americans and people of Middle Eastern descents for example. (and they have larger lips to begin with....as their skin is thicker)

Treatment of lip wrinkles is a challenging problem. I tell patients to think of it as improvement as there is no complete cure in most cases. For small and fine lines that are mainly located at the junction of the skin and the lip, an injectable filler can make a nice improvement...provided you find it acceptable to have a larger lip size. (whichever you desire) When the lip wrinkles are deeper and run higher into the upper lip, the concept of skin resurfacing comes into play. This typically means lase resurfacing and the question is how deep to go with how long of a recovery that will be acceptable to the patient. When the lip lines and wrinkles are more severe, I usually use a combination of making the lip bigger with injectable fillers and resurfacing the skin with a laser. This is usually done under local anesthesia in the office unless the patient is having other major facial surgery, such as a facelift, where the procedure would be then performed in the operating room. There is some current debate between the laser techniques of resurfacing or peeling and the use of fractional (fraxel) laser treatments, but there is no hard clinical evidence at this point to say conclusively that fractional laser treatments are better. In the more severe cases, a small amount of Botox to help reduce the amount of muscle movement can also be helpful when done with fillers or laser resurfacing but you must be careful to not use to much lest you make your smile have an unnatural appearance.

Alternative treatments for lip wrinkles through skin modification are currently being evaluated. One method is to combine laser resurfacing with the use of sandpaper (yes I said sandpaper), known as laserbrasion. With laserbrasion, a combination of upper skin removal is done first with the laser and the deeper skin areas are taken down with sandpaper. The concept here is that the use of sandpaper causes less trauma (no heat) and will heal faster without the prolonged redness. And it is just as effective as the laser but safer and with less complications than if one used traditional dermabrasion. The other method is known as percutaneous collagen induction therapy. (PCIT) Like aerating your lawn, making very tiny holes throughout the upper lip with a small wheel lined with microscopic needles cuts into the deepest portions of the skin. As this heals it causes the skin to thicken which helps reduce the amount of visible wrinkling.

Upper lip wrinkles in some women are unavoidable and can be very troubling. Injectable lip fillers, laser resurfacing, and Botox can help but there is no permanent cure. The alternative treatments of fractional laser treatments, laserbrasion, and collagen induction therapy are interesting but it is too early to know if they will offer better results.

By Dr Barry Eppley

Combined Fractional Laser Skin Resurfacing - New Cosmetic Laser Treatment For Wrinkle Removal

All of us over 30 begin to see distressing signs of facial aging and sun damaged skin. Sun worshippers and smokers see these skin aging changes sooner. Fractional laser skin resurfacing, a non-surgical anti-aging skin rejuvenation method was introduced several years ago as an improved method for wrinkle removal and facial skin rejuvenation. 

Fractional laser skin resurfacing was developed to eliminate many of the problems associated with traditional old time laser skin resurfacing. Traditional laser skin resurfacing was very effective at wrinkle removal, but recovery was long and difficult and the skin often turned white, called hypo pigmentation, 6 months after treatment. Fractional laser skin resurfacing was developed to remove wrinkles and rejuvenate the skin with minimal downtime, quick recovery and normal skin color and texture after the skin rejuvenation procedure. 

Recently, a new technique called combined fractional laser skin resurfacing has been developed to improve wrinkle removal and skin rejuvenation results. This new technique provides much better wrinkle removal and skin rejuvenation, but also plumps and improves the texture of aging skin much better than previous techniques.

How Does Fractional Laser Skin Resurfacing Remove Wrinkles and Rejuvenate the Skin?

The basic cause of skin wrinkles and skin aging changes is loss of collagen in the skin. Collagen in the deep layer of our skin provides moisture, nutritional support, skin plumping and elasticity which is the firmness and skin tightening component of our skin.

As we age, exposure to years of ultraviolet (UV) radiation from sunlight, toxins in our diet and environment, and unhealthy lifestyles such as smoking and tanning all contribute to the destruction of collagen in our skin. When collagen is lost, our skin looses texture, elasticity and fullness, and wrinkles and sagging skin result. For an analogy, think of a plump juicy plum with smooth skin. Place the plum into the sun for a period of time, water (like collagen in the skin) is lost and the plum turns into a wrinkled prune.

In an effort to protect itself, our skin surface responds to these aging changes by producing pigment to block the UV sunlight, and our skin thickens with extra layers of dry old looking skin.

All cosmetic laser skin rejuvenation methods attempt to restore skin to a youthful state by stimulating the skin to grow new collagen to replace lost skin collagen to plump and tighten loose skin.  In addition, many cosmetic laser skin rejuvenation methods strip away the damaged surface skin cells to remove pigment and dead thickened skin and stimulate new healthy looking skin cells to grow.

Fractional laser skin resurfacing is a skin rejuvenation technique which removes dead surface skin cells and pigment and stimulates the deep layer of the skin, the dermis to produce new collagen to replace the collagen that has been lost by facial aging changes. In summary:

Skin aging is results in:

•        Loss of collagen in the skin=wrinkles and loose skin
• Skin surface changes=dry, pigmented, course skin

All cosmetic laser skin resurfacing methods rejuvenate skin by:

• Removing aged skin surface cells and promoting new skin cell growth
• Promoting new deep skin collagen to plump wrinkles and tighten skin

Why is Fractional Laser Skin Resurfacing Better?

Older CO2 laser resurfacing, called flat beam laser resurfacing produced excellent wrinkle removal and skin tightening, but recovery was very difficult, requiring weeks for the skin to heal. In addition, traditional laser skin resurfacing damaged pigment cells in the skin which caused the skin to turn white. These problems were caused by the fact that the older lasers treated the entire surface of the facial skin, thus healing required new skin cells to be produced by hair follicles and sweat glands in the skin. This was a very slow process requiring up to two weeks for new skin cells to cover the surface of the face.

New fractional laser skin resurfacing is effective but much safer than traditional CO2 resurfacing. The fractional laser resurfacing beam is broken up into many small beams so that the laser affects only small focused areas of the skin. Fractional laser resurfacing leaves skip areas on the skin that are left normal and undamaged. These untreated skin cells are able to rapidly heal the treated skin with new skin cells. The treated areas, called micro treatment zones are healed in 6 hours with the fractional Lux2940 Erbium laser on the Starlux laser. CO2 fractional lasers like the Fraxel Repair and Lumenis ActiveFX and DeepFX take a little longer, up to 48-72 hours.

Fractional lasers are also able to penetrate the skin into the dermis much deeper than flat beam techniques. Deeper penetration causes more effective new collagen production. This characteristic results in improved skin plumping and better skin texture.

Fractional laser skin resurfacing is better than old time flat beam laser resurfacing because skin healing is much quicker, and the risk of white skin, hypo pigmentation is much less.

The benefits of fractional laser skin resurfacing are:

• Quicker skin healing
• Deeper penetration for better collagen production
• Less risk of hypo pigmentation
• Improved skin texture
• More gentle, quicker recovery
• Improved wrinkle removal, pigment removal and skin tightening

What Is Non-ablative Fractional Laser Skin Resurfacing-Fraxel, Starlux Lux1540, Affirm

The first fractional lasers were introduced 3-4 years ago and are non-ablative 1450nm and 1540nm (nm=nanometers or one millionth of a meter, and are the units used to measure the wavelength of a particular laser) Erbium lasers. Non-ablative laser skin treatments go deep into the dermis of the skin to promote new collagen, but non-ablative lasers to not ablate or remove the surface skin cells.

Thus the non-ablative fractional skin resurfacing lasers remove wrinkles by building new collagen in the skin, but do not remove the surface aging changes of the skin.

The benefit on the non-ablative technique is that there is less recovery time for healing as the skin is not broken. You are pink after a treatment, but can wear makeup and no recovery time is required.

Because non-ablative treatments are weaker, you need 4 treatments scheduled 4-6 weeks apart for a good result.

I use the Starlux Lux1540 non-ablative laser; other models are the Fraxel and the Affirm. The best applications are acne scar removal, scar improvement, skin plumping, pigment removal and mild to moderate wrinkle removal

Because the skin surface is not ablated, wrinkle removal is less effective with the non-ablative lasers, thus new ablative fractional laser resurfacing technology has been developed in the past year and a half.

What Is Ablative Fractional Laser Resurfacing

For ablation, different laser wavelengths, the 2940nm Erbium laser and the CO2 laser are used. These laser wavelengths are more powerful and vaporize the skin cells on the surface as well as causing inflammation deep into the dermis.

Because surface skin cells are removed, the ablative fractional lasers are more effective at removing wrinkles, pigment, and old dead skin cells. The downside is that some recovery is required for skin healing, however the down time is much less, about a third of the time required recovering from old time flat beam laser skin treatments.

The other benefit is that ablative fractional laser skin resurfacing requires only one treatment, as opposed to the 4 treatments required for non-ablative techniques.

I use the Starlux lux2940 fractional ablative laser resurfacing method. The Starlux Lux2940 is an Erbium laser and heals faster than the fractional CO2 lasers, the Fraxel Repair, the ActiveFX and DeepFX ablative machines. 

What is Combined Fractional Laser Skin Resurfacing and Why is It Better?

The newest and most effective cosmetic laser skin rejuvenation treatment I combined fractional laser skin resurfacing. After two years of research and over two hundred treatments, we have learned that combining the Starlux Lux1540 non ablative treatment with the Starlux lux2940 ablative treatment provides the most effective wrinkle removal and skin rejuvenation treatment.

The Starlux Lux1540 and Starlux Lux2940 are done in the same treatment session. The results in terms of wrinkle removal, skin plumping, improved skin texture, pigment removal and general skin rejuvenation are excellent and better than either treatment done alone.

This is a very new technique; I just presented our findings in Dallas, Texas at the Palomar Medical Advanced laser seminar on January 24, 2009. We have been working on this project for over two years.

How Is Combined Fractional Laser Skin Resurfacing Done?

The combined fractional laser skin resurfacing treatment is done in my office with a topical local anesthetic cream. Your face will be cleansed and a topical numbing cream applied. I also give you a tranquilizer and an analgesic to help you relax and be more comfortable during treatment.

The Starlux Lux1540 treatment is done first by my medical aesthetician and takes about 30 minutes. Numbing medicine is re-applied, and I or my plastic surgeon associate do the actual Starlux Lux2940 ablative treatment.

After your treatment we apply cold wet compresses to the skin. Then a soothing ointment will be placed on your skin, and you will go home. During the first 24 hours you will place soothing soaks on your skin and apply ointment every few hours.

By day 2 or 3 you will finish the soaks and only apply ointment as you need it.

You will be given analgesic tablets in case you need them and Valtrex to protect you from a Herpes Skin outbreak. We also give you prophylactic antibiotics to protect against skin infection during healing.

What Will I look Like After Treatment and How Long Is Recovery?

Your skin will be pink to red after treatment. The first 24 hours your skin will be moist and old skin cells will peel off and be removed by the soaks.

Your new skin will cover your face in 2 to 3 days, very different from the 2-3 weeks required for skin healing after the old time float beam laser treatments.

Your face will remain pink for 5-7 days, but you can wear make up by day 4. This is about a third or fourth of the recovery time from a deep chemical peel or an old time flat beam laser treatment. 

When Do I See My Final Result?

You will see a remarkable improvement in wrinkles and skin texture with fresh new skin starting at 10 days and for the first 3 weeks. However, new collagen production, the main goal of this treatment does not begin for 6 weeks and continues for one year after treatment.

The initial benefits are due to swelling of the skin which subsides at about 3-4 weeks so expect to see your wrinkles return initially.

However at 3 months you will really start to see the improvement in your skin and at 6 months results are very dramatic.

In my experience, wrinkle removal, skin tightening and improvement in skin plumping and skin texture are most obvious at one year following treatment.

How Do I Find A Doctor Who Uses This Technique?

Board certified plastic surgeons and dermatologists are the experts at laser skin rejuvenation treatments. Ablative laser resurfacing is more commonly done by plastic surgeons because of the complexity of skin care after the procedure.

The new combined technique is so new that it will be some time before it is widely practiced.

Be certain that your physician is board certified and has experience in laser surgery-there are many new users of lasers who simply do not have the experience required for these advance laser treatments.

By Brooke R. Seckel, M.D., FACS