Dermatologist Jeffrey S. Dover, M.D., frequently deals with the challenge of treating vertical lip lines at his Chestnut Hill, Mass., practice. He says traditional treatment options using neurotoxins or filler injections are far from optimal.
“Upper lip lines — vertical lip lines — are very difficult to treat, and when you survey most women it’s near the top of their hit parade of things they dislike the most,” Dr. Dover says.
But there is an approach, which he and his practice colleagues refined, that uses laser-assisted delivery of topical poly-l-lactic acid (PLLA) to treat upper lip rhytides. Dr. Dover was senior author on a paper published July 2019 in Dermatologic Surgery suggesting laser-assisted delivery of PLLA is a safe and might be effective for treating the pesky lines.1 He tells Dermatology Times his practice has since done nearly 100 cases using the approach, and he is a believer.
Current Treatment Options
Dr. Dover says clinicians most commonly use either neuromodulators or fillers to treat upper lip lines.
Using neuromodulators tends to be the simplest and least expensive of today’s options and aims to gently weaken the patient’s pucker and the approach is used because it addresses one of the root causes of the lip lines.
But getting good outcomes can be tricky.
“If you use too high a dose, the patient won’t be able to speak or drink from a straw or even out of a glass,” Dr. Dover says. “A very low dose works, but it takes months to see improvement. We believe that if it’s done on a somewhat regular basis, every three or four months, you can stop the natural progression, and slowly but surely the lines start to soften.”
Another option is to gently fill the upper lip lines with a soft hyaluronic acid (HA) filler. Dr. Dover’s favorites for the task are Volbella (Juvederm, Allergan), Restylane Silk (Galderma) or Belotero (Merz).
“Fillers work, but it’s painful. It often causes swelling and bruising and it doesn’t last that long,” he says. “It works well in conjunction with neuromodulators and when lip lines are fine, but it’s doing nothing to actually reverse the cause. That’s why we started to look at other potential ways to improve these lines and to improve photoaging around the mouth.”
The OMAR Approach
In a study published June 2014 in Dermatologic Surgery dermatologist researchers showed they could treat atrophic scars by using fractional ablative laser resurfacing by making thousands of little holes in the skin and applying PLLA, to where the liquid filler entered the holes.2
“This was one of the earliest studies in the field now called laser-assisted drug delivery,” Dr. Dover says.
Dr. Dover receives research support from and has consulting agreements with Lumenis and Solta (Bausch).
1. Ibrahim O, Ionta S, Depina J, Petrell K, Arndt KA, Dover JS. Safety of Laser-Assisted Delivery of Topical Poly-L-Lactic Acid in the Treatment of Upper Lip Rhytides: A Prospective, Rater-Blinded Study. Dermatol Surg. 2019;45(7):968-974.
2. Rkein A, Ozog D, Waibel JS. Treatment of atrophic scars with fractionated CO2 laser facilitating delivery of topically applied poly-L-lactic acid. Dermatol Surg. 2014;40(6):624-31.