Botox for “Smoker’s Lines” (Even In Non-Smokers)

smoker's_linesAs many of you know, Botox is used to relax muscles and smooth wrinkles primarily in the upper face.  The most common areas treated are, in order of popularity:

  1. Between the eyes (scowl lines)
  2. Around the eyes (smile lines or crow’s feet)
  3. The forehead

While these areas represent the vast majority of Botox that I inject, there are lesser-known areas of the face where Botox is used.  I thought that a series of blog posts about those areas may enlighten you on the other uses of this marvelous medication.

In the lower face region, a very common area of concern for wrinkles is around the mouth.  These are known medically as perioral lines.  In layman’s terms, rightly or wrongly, they are best known as “smoker’s lines”.

botox_smokers_linesWhile the deeply creased vertical lines in the lips can be caused by smoking, it is not the only cause of perioral lines.  They also can result from excessive sun exposure over the years, and even as a hereditary predisposition.

Understandably, non-smokers are particularly upset about these lines as many assume that they are really smokers when the lines develop.  Lipstick wearers also find it upsetting when their lipstick bleeds vertically into these lines and seems to highlight them further.

I will frequently use dermal fillers such as Juvederm Ultra to plump up the deepest premolar lines, but this treatment can unfortunately sometimes leave the upper lip particular swollen for several days.  For less deep lines, Botox can be injected in the premolar area to soften both upper and lower lip creases.

When I am asked to evaluate premolar lines, I like to see the extent and the depth of the creases both at rest and when in motion.  I usually ask the person to purse their lips as if they were blowing out a candle.  This maneuver usually defines the most prominent creases in more detail.

I also assess the individual for any preexisting asymmetries to the lips of which they might not have been aware or about which they have forgotten.  Occasionally, a scar from a childhood accident or a repeated movement of one side of the mouth due to a dental issue can result in one side looking slightly different.

botox_lipsKnowing these sorts of details is important because using Botox or even fillers in that area might exaggerate the differences from side to side.  We need to know the baseline status before we do any intervention.

Because the perioral muscles are much weaker than other areas of the face such as between the eyes, smaller doses of Botox are needed for such weaker areas.  I need to inject enough Botox to achieve an effective and acceptable improvement in the appearance of the lip without affecting the important functions of the mouth and lips themselves.

I always caution those who cannot tolerate the slightest weakness in their lip muscles, such as singers or players of wind instruments.  Otherwise, the weakness of the lip muscles caused by Botox is not noticeable with regular activity such as speaking or eating.  You may, however, have some problems with whistling or sucking hard on a straw.

In the right person with lines around the mouth, Botox can add to the treatments available to treat this condition.  It does require more advanced experience with using Botox in this area, and the medical judgment to discuss this and other options.

I have treated many, many people for lip creases with Botox over the years with excellent success.  If you or anyone you know has this issue and are considering treatments to remove these lip lines, call us at (207) 873-2158 for a free consultation to discuss options.

About Dr. John Burke

John Burke M.D. has practiced medicine for over 25 years, and is the founding partner of MidMaine Internal Medicine. He established Maine Laser Skin Care in 2004 after devoting years to learning the latest in laser and dermatologic technology. Dr. Burke has treated patients from all over the United States. He is one of Maine's busiest practitioners in laser treatments, and in the use of Botox for upper facial lines and excessive sweating.
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