The lips serve critical life functions of eating and speaking. They serve an important social purpose and convey emotions and affection. The function and the aesthetic of the lips are closely interrelated and cannot be separated. The lips consist of the red (vermillion) portion, and the skin (cutaneous) portion.
An aesthetic lip region consists of special proportions between the relative heights of the red and skin portion of the upper and lower lips. The upper lip also forms a gentle bow with two peaks. Beautiful lips are covered by smooth and blemish-free skin and are free of wrinkles at rest and at animation. The lips are central to the image of youth, attractiveness and sensuality in women and increasingly in men as well.
Smokers’ lines are wrinkles that originate from the lip skin and lie radial to the lip. They may extend into the red portion. They are most prominently displayed when individuals pucker their lips. Smokers’ lines may be dynamic (intermittent) or static (permanent). These wrinkles may start to manifest in the forties, and are often more prominent in smokers and individuals who are slim.
There are two simultaneous processes that contribute to the formation of smokers’ lines: thinning of the lip skin and gradual loss of the subcutaneous fat. As we age, the skin becomes thin and loses elastin and collagen fibres and becomes thin. The underlying subcutaneous fat also loses volume and thickness due to changes in the metabolism of adipocytes (fat storage cells). When speaking or eating, the orbicularis muscle contracts and exerts visible traction on the skin surface resulting in these wrinkles. Skin thinning is accelerated in smokers and hence its name, “Smokers’ lines”.
Smokers’ lines are reliably treated with botulinum toxin or nanofat injection. Both are effective and safe treatments in the experienced hands, and attain a high degree of satisfaction in most cases.
The popularity of botulinum toxin injection has grown rapidly since the 1990s, and it is now one of the most commonly administered procedures in the world. Botulinum toxin reduces signs of ageing by the partial weakening of the orbicularis oris muscles that cause the formation of Smokers’ lines.
Individuals with shallow and dynamic smokers’ lines are best candidates for this treatment.
We frequently see or hear of people who look unnatural following aesthetic treatments. This is often due to practitioners who attempt to reverse all the signs of aging by using botulinum toxin alone, resulting in stiff and unnatural results. Botulinum toxin effaces wrinkles by partial weakening of the orbicularis oris muscle but does not reverse skin and muscle laxity or fat atrophy. Attaining bespoke and natural-looking results that retain an individual’s expressivity is frequently possible and requires accurate assessment, appropriate product choice, precise administration by an experienced practitioner.
Botulinum toxin causes partial weakening of the orbicularis oris muscle that is involved in the formation of smokers’ lines. The dose and number of injection points are tailored according to individual anatomy and severity. Injection of the smokers’ lines is a delicate art balancing the desire to remove the wrinkles whilst preserving optimal muscle function to allow natural facial expressions.
The effects of botulinum toxin generally take 1 to 3 days to be observed, and will last for 4 to 6 months. Repeat treatments are necessary for maintenance of the result.
Individuals are advised to avoid vigorous massage to the treatment area for 2 hours following the injection. This is to prevent spread of the botulinum toxin, which may result in potential unintended adjacent muscle paralysis. Individuals may resume their usual activities immediately following the procedure.
Nanofat injection involves harvesting fat graft from areas of excess. This fat is purified and emulsified using proprietary techniques, then injecting this fine mixture containing adipose-derived stem cells (ADSCs) into the smokers’ lines. Nanofat injection provides natural-looking results and long-term improvement as compared with botulinum toxin injection. Nanofat injection is a minimally-invasive ambulatory surgical procedure performed under local anesthesia, with optional intravenous sedation if requested.
Individuals with any degree of smokers’ lines and seeking long-term improvement may consider nanofat injection. Individuals with other areas of hollowing and volume loss may undergo concurrent structural fat grafting to the face, neck, or hands and achieve simultaneous benefit in multiple sites. Those with severe hollowing will benefit from significant cost saving in the long term as compared with recurrent treatment using large volume filler injection.
Common sites for fat harvest include the inner thighs, hips, flanks and lower abdomen. Small incisions are made near the areas of intended liposuction, and a local anaesthetic is infused for optimal intra- and post-operative pain relief. The fat is broken up and aspirated under negative pressure. It is purified and emulsified using proprietary techniques. The fat particles are gradually reduced in size until the final mixture is almost liquid-like and behaves like a natural, biological filler. During the emulsification process, the larger adipocytes (fat storage cells) are destroyed, leaving the smaller adipose-derived stem cells (ADSCs) within the mixture. These are injected into the crow’s feet, and it is thought that the ADSCs exert regenerative effect on the skin in addition to filling the deficient volume. Nanofat injection improves the quality and pigmentation of the overlying skin and is its unique advantage over synthetic fillers.
Many individuals are able to return to work on the day after the surgery. Depending on the extent of fat harvesting performed, most of the swelling and bruising will resolve by the 7th postoperative day. Stitch removal is usually performed on the 5th postoperative day.
Individuals are advised to avoid pressure on the injected areas to optimize the final result. Postoperative swelling is reduced by remaining upright during the daytime and by elevating the head of the bed with extra pillows when asleep at night. Individuals may return to their original exercise and gym routines after 2 weeks.