Upper lips lines – why is this area so tough to treat?

I have vertical lip lines---on one side they are dynamic. My derm says they are moderate. The first time he used restylane on them, it looked good and it lasted nearly six months. Then he decides to put perlane in--was a lumpy mess. Finally, we get back to restylane but it stays puff looking and isn't dissolving evenly on the side with dynamic wrinkles. I know he overfills somewhat because my mouth looks like a duck for at least two weeks after. He says I need volume in the upper lip as well as the lines filled. Why does it get puffy and look uneven four or five weeks later?

This IS a tough area because there are 3 problems: loss of volume, dynamic wrinkles (caused by muscle action) from kissing, talking, smoking, etc. and sun damage on top.  And to some extent, a genetic tendency.


Some thoughts to help:

  • On almost everyone, Juvederm causes less swelling and puffiness in the lips than Restylane. My vote would be for the Juvederm Ultra (mid weight) or the Merck product Belotero, both are lighter and less likely to cause the puff problem;
  • Your doc is probably right about the volume but at this point with some problems recently, it’s better to just let it all wear off for several months and start over when you are completely back at baseline. It’s very difficult to keep “chasing” a not great result.
  • Botox or Dysport are really the best for dynamic wrinkles but it needs to be done very lightly so you can still eat and drink without problems. If there is a little asymmetry, a little Botox just on that one side may be an option to discuss with your doctor;
  • Your doctor’s “eye” and technique need to be good. The trick is to support the skin and contours all around the lips and not just “do the lips” and to get the proportions between the upper and lower lip right so that it looks better, completely natural and not puffy. That’s the goal;
  • The French have a technique that I like where they just put small droplets of filler in the body of lip to hydrate them (keeps the shape natural) and then treating the borders and lines very lightly and making sure the entire perioral area is well supported.


Hope this helps,   Dr. I


Learn more about treatment for frown lines on the forehead by reading Guide to Botox and Dysport.


Check out an article by Dr. Irwin for sagging skin treatments: Jaw Line and Chin Issues.

Dr. Brandith Irwin, MD

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