Your Questions
Your Questions
Q: Dr. Eppley, I am a 42 year-old white female who has the beginnings of lip lines. I don’t smoke and have never tanned excessively. I have fairly pale skin. While my lips have never been really big they have never been thin either and have always had good shape. I have noticed over the past few years that I am getting several noticeable lines in my upper lip. My lipstick now is starting to bleed into the upper lip along these lines. My lips still have some shape but they are beginning to lose their shapes. What can I do to get rid of these lines and get some plumpness back to my lips?
A: Vertical lip lines or wrinkles are one of the peskiest facial aging problems. They are not easy to treat and they are relentless…always fighting to come back no matter what is done. Lips lines, like all wrinkles, appear because of underlying muscle action. The mouth is encircled by a ring of muscle known as the orbicularis oris. Anytime you pucker your lips or suck on a straw, this muscle is activated and contracts. Wrinkles appear on the overlying lip skin perpendicular to the direction of the muscle movement, thus the appearance of vertical lip lines. The thinner the lips one has (most common in Caucasian females), the more likely that lip lines will appear. Since it is impossible and impractical to completely stop moving your mouth (although not sucking on a cigarette or water bottle helps), treatments must be directed toward either inducing some muscle weakness (dilute Botox injections) and/or plumping up the lips by injectable fillers. In more advanced lip aging with a greater number and deeper lines, laser resurfacing or dermabrasion must be considered.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I recently had Botox injected into my lips to help treat my lip lines. I was not pleased with the results at all. Besides not getting rid of any of the wrinkles it also gave me the unhappy effect of making my upper lip look funny (not in a good way) when I smile. I happened to have heard on my way out when paying my bill that this was the first time the doctor had ever injected Botox into a lip. I am upset that I paid for not only no result but that it may me look worse. On my own investigation I read on the internet that Botox is only approved for use in the forehead. I think I should get my money back and maybe even sue the doctor. What do you think?
A: Botox is used for a wide variety of aesthetic facial applications. It was initiallystudied and subsequently cleared by the FDA for glabellar (between the eyebrows) wrinkles and is known as an ‘on-label’ use. Despite this one approved cosmetic use in the face, it is a perfectly acceptable medical practice to use Botox for numerous other expression-reducing/wrinkle reduction indications. This is known as ‘off-label’ use and is commonly done with many drugs. It is neither wrong nor malpractice to do so. The use of Botox in the upper lip can be effective at wrinkle reduction but is technique and dose sensitive. Unfortunately for you, this effort did not turn out to produce the desired effect. The good news is that your Botox will wear off in a few months and you will return completely to normal. I would discuss your dissatisfaction with the treating doctor and see what accommodations they may be willing to do.
Dr. Barry Eppley
Indianapolis, Indiana