Lines around the mouth

The first is muscle. The orbicularis oris circles the mouth and does an enormous amount of work: speaking, eating, drinking, kissing, pursing. Every contraction folds the skin above the lip in the same place, and over decades that fold gets etched in.

The second is skin quality. The skin above the upper lip is thin, has relatively few oil glands, and loses collagen early. As it thins, it holds a crease that plumper skin would spring back from.

The third is volume. The upper lip and the philtral columns lose support with age. When the structure beneath the skin deflates, the skin above it has nowhere to sit and gathers into vertical lines. This is the cause people least expect and it is often the biggest contributor.

Smoking accelerates all three — the repeated pursing, the collagen damage, the reduced blood supply — which is where the name comes from. But sun exposure does much the same, and so does simply getting older.

Treat only the muscle and the lines soften but the skin still looks crepey, because you have not changed its quality. Treat only with filler and the movement keeps re-etching what you have just smoothed. Treat only the skin and the underlying support is still missing.

In practice a combined, staged plan does far more than any single intervention. My usual sequence is to restore support first, treat skin quality alongside it, and consider a small amount of muscle relaxation last — because relaxing that muscle too early or too heavily creates problems of its own.

The muscle around the mouth is functional in a way the forehead is not. Over-relax it and people notice: difficulty with a straw, an odd feeling when pronouncing p and b sounds, an asymmetric smile, sometimes trouble keeping liquid in the mouth. It resolves as the treatment wears off, but three months of that is a long time.

So the dose here is a fraction of what would be used in the frown, placed superficially and conservatively. Anyone offering you a standard dose in this area has not thought about it. If you sing, play a wind instrument, or speak or present for a living, say so — it changes what I would recommend, and sometimes it means I would not recommend it at all.

Very small amounts of a soft product placed into the lines themselves can help where the line is etched and static. It is technically demanding: the skin is thin, product placed too superficially shows as a white or lumpy ridge, and this area is unforgiving of a heavy hand.

More often the better move is to support the vermillion border and the philtral columns rather than filling the lines directly — restoring the structure the skin sits on, so the lines have less reason to gather. The result reads as a lip that looks like itself rather than a lip that has been worked on.

Microneedling and appropriate peels genuinely improve the etched component by prompting the skin to remodel. Polynucleotides and skin boosters improve density and hydration in an area where thin skin is a large part of the problem.

This is the slowest part of the plan and the part people are most tempted to skip. It is also the part that determines whether the result still looks good in two years, because a line etched into poor-quality skin will come back faster than one in skin that has been improved.

Daily SPF, because UV is the single largest contributor to the collagen loss underneath these lines. A retinoid, used consistently, which does more for skin quality above the lip than most in-clinic treatments do on their own. And stopping smoking if you smoke — which improves the blood supply to an area that has very little to spare.

None of that is exciting advice and all of it works better than it sounds.