Upper lip lines and under eye wrinkles are common concerns to both men and women. The incidence of these concerns increases with age and is more common in females and fairer skin types. What causes these wrinkles and skin changes that could drive people to seek cosmetic treatments to improve them?

There is no one reason for ageing in the periocular or perioral area, but sun exposure, smoking, ageing (loss of volume and loss of collagen in these areas), occupation (e.g. outdoor based work), hobbies( e.g. saxophone enthusiast) and genetics all have influencing factors in how much wrinkling or ageing shows in these areas at an earlier age or later age in each person.

What Treatments are available?

The skin after laser resurfacing is red, and raw for a period of time (usually 5-10 days). The downtime depends on the depth and severity of the wrinkles/lines and skin issue treated, as well as the age of the skin and health of the patient. It also is dictated whether full ablative erbium laser is used (6-10 days healing time) or fractional erbium laser is utilized (3-5 days healing time). This downtime can be accelerated with appropriate post laser skincare, Healite 2 LED treatment and the application of Platelet rich plasma (immediately post laser resurfacing).

For medium and deeper wrinkles, more than one laser treatment is usually required to improve the area. These are usually spaced a few months apart. It is usually advisable to treat the full face, rather than just the upper lip or under eye area, with the focal areas receiving more “love” from the laser, with the aim to blend in the new skin in an optimal manner.

In general Laser based treatment can have more improvement to skin wrinkling and ageing then other options such as dermal fillers, fractionated radiofrequency micro-needling, HIFU (Ultraformer 3), anti-wrinkling injections. As well as having longer lasting rejuvenating benefits.
But the downtime from ablative laser needs to be considered by patients, and it is this factor that sometimes paves patents to seek other treatments which can improve static or dynamic wrinkles with less recovery time.

Ablative Erbium laser treatments can be associated with side effects. These can be pigment related (darkening or whitening of the skin, grid or line patterns on the skin), infection (bacterial, viral or fungal), acne breakout, milia (white spots under skin surface), prolonged redness of the skin, and scarring (rare).

With careful patient selection, treatment planning (prophylactic skincare and antibiotics and antivirals (i.e. cold sore prophylaxis), great laser (Fotona Erbium 2940nm), experienced Laser Doctor, and good aftercare, the risks can be minimized and be managed well if occur.

2. Fotona SmoothEye (Erbium 2940nm Non-Ablative Smooth mode)

The Fotona Dynamis Erbium laser has the unique ability to operative in both an ablative manner (traditional Erbium mode) and also a Non ablative mode (skin tightening mode). The Fotona SmoothEye treatment aims to tighten and smooth wrinkles around the eye area in a non-ablative mode. Laser energy (Erbium 2940nm) is used in a unique non ablative mode called “Smoothmode”, which safely heats the superficial aspect of the skin around the delicate eye area, stimulating the production of collagen and also tightening existing collagen and elastin fibres to smooth and tighten the area treated. This treatment requires a minimum of 3 treatments spaced 4-6 weeks apart to allow skin rejuvenation to occur. The final result is usually achieved 3-4 months after the final treatment visit. The treatment involves the application of a topical (doctor strength) local anaesthetic gel for 45 minutes prior to the treatment. The laser treatment usually lasts approximately 20-30 minutes and is usually quite tolerable. There is some mild swelling and redness that usually dissipates over 1-2 days. There is no downtime or pain post the treatment, and normal activities can be undertaken straight away. Its recommended to avoid steam rooms, saunas, vigorous exercise for 24 -48 hours post treatment.

This treatment can be used as a standalone treatment or be combined with other modalities to achieve better results (e.g. Ablative Erbium resurfacing or Secret RF micro- needling).

3. Dermal Fillers (HA based fillers) & Anti-wrinkle Injections

Non-permanent fillers (HA) have been used for skin rejuvenation for over 15 years with good effect. This treatment involves a fine needle or cannula (blunt needle) to place a specific amount of gel composed of a sugar into different depths of the skin to achieve a specific outcome, either volumize the area (e.g. under eye hollowness) or soften or reduce static wrinkles or lines (e.g. “smokers lines” of the upper lip). The outcome is immediate, and the treatment is well tolerated with mild to minimal pain. The filler also contains a local anaesthetic (“numbing ingredient”) to facilitate the treatment, which lasts usually less than 20 minutes. Dr Omarjee will sometimes also place a medical grade topical anaesthetic gel to the upper lip area skin prior to dermal filler to further make his patients a ease during the injecting process.

Dermal fillers (HA) can be a good option for some patients with static wrinkles in the upper lip area or for volumizing hollowness in the under-eye area, or also known as the tear trough area. The results can last for months to up to 2 years in some people after one treatment. There is usually no downtime, except the possibility of some bruising (mild to moderate on average), and temporary swelling for a 1-2 days in most patients.

For upper lip lines, there are static and dynamic lines to address. Dermal fillers work in 2 main ways to improve these lines; volumizing the upper lip area between the skin and the deeper muscle (orbicularis oris), like inflating a balloon, creating a more convex smoother and less lined appearance. And secondly injecting into the vertical orientated lip lines to make them shallower and blend more with surrounding skin.
Dr Omarjee usually likes to add anti-wrinkle injections into the upper lip area also to reduce the activity of the orbicularis muscle, which reduces some of the dynamic lip lines. This quick and beneficial effect usually takes 1-2 weeks to reach its optimal result and complements the dermal filler volumizing. Hence the combination of dermal filler and anti-wrinkle injection is a good treatment, with minimal to no downtime, and can improve the upper lip area (as well as lower lip area lines) to a nice extent. It is important to balance the amount of dermal filler and anti-wrinkle injection to reduce any side effects, which if occur are usually short lived (a few weeks) These can include prolonged swelling in area of dermal filler, difficulty whistling, a mild numb feel to the upper lip area and mild dribbling when drinking from a cup. The anti-wrinkle injection treatment needs to be repeated every 3 months on average and the upper lip filler every 5-6 months.

For the undereye area (tear trough area), if deemed suitable a dermal filler can be placed to increase the volume in this area and reduce the shadowing that occurs as a result of volume loss. This volume loss can actually start from an early age as of genetic factors and will usually steadily worsens over time, giving the individual a hollow or tired appearance. The actual placement technique and choice of a very specific type of filler in this complex area is critical to the success of treatment of tear trough rejuvenation. Dr Omarjee prefers to use a cannulae (blunt needle) approach to volumizing tear troughs to minimize risks with treating this area. Some of the rare complications associated with dermal fillers anywhere on the face are related to vascular occlusion, which can lead to skin loss (necrosis) and associated scarring and worse still, irreversible blindness. Blindness is a rare complication of dermal filler and is more associated with midline injections of dermal filler (e.g. nose, forehead/frown area, temples). Like with all medical treatments, it’s imperative to know the risks, potential benefits of the proposed treatment, as well as the qualifications and experience of your injector.

Antiwrinkle injections can also be utilized in some people for under-eye area wrinkles. Each patient is assessed to see if their skin is suitable for this treatment. The orbicularis oculi muscle in the under-eye area can be partially relaxed to reduce under-eye wrinkling, but this benefit needs to be balanced with maintaining lower eyelid function and lymphatic drainage of this area. Also, the skin on the lateral part of your eyes can reflect your age (known as the “crow’s feet” area), a little Dr Ed magic with anti-wrinkle injections in this area is usually very rejuvenating to the whole ocular area.

4. SECRET RF (Fractionated Radiofrequency micro-needling)

Secret RF is a new novel anti-ageing technology, providing patients with a safe and effective way to restore the radiance and youthfulness of their skin. The Secret RF system uses fractional bipolar radio frequency (RF) and micro-needling to tighten the skin and reduce lines and wrinkles by stimulating and remodelling collagen.

RF is essentially electrical energy, and Secret RF gently and safely heats the skin in the dermis to approximately 60 degrees Celsius.
Secret RF is not similar to standard micro needling (i.e. Dermapen), it is a combination of RF (radiofrequency) therapy and micro-needling. This synergy sets fractionated RF micro needling in a different league for potential results and balancing safety with the ability to set bespoke customized treatments with insulated or non-insulated gold-plated microneedles.

Secret RF induces dermal remodelling by applying precisely controlled RF energy via 25-64 ultrafine, disposable gold-plated needles directly into various depths of skin from 0.5-3.5 mm. The depth of the needle that is chosen is dependent on the area being treated (e.g. under eye area is penetration depth is shallower than cheek area). The doctor also has the ability to choose the strength of the radiofrequency energy being delivered through the micro-needles precisely into the dermis to individually tailor the treatment to each patient. The higher the RF energy delivered the more potential for skin tightening and rejuvenation, but the higher the discomfort during the treatment and length of downtime post treatment.
The Secret RF micro-needling device provides a unique combination of non-insulated or semi-insulated needles that let you treat a wide range of applications for all skin types, including challenging skin. The main advantages of RF micro-needling is that it can offer similar results to ablative laser procedures, but with significantly less discomfort, downtime and risk for hyperpigmentation (especially in darker skin types).

In the under-eye area or upper lip area, you can expect some redness and tingling immediately post your treatment. Most people describe the feeling similar to a sunburn sensation. Their maybe some mild swelling in the areas treated. The redness and swelling usually resolves over 1-2 days. There can be some mild bruising in these delicate skin areas, rarely significant. This bruising if occurs resolves usually rapidly over days.
The micro injuries created in the upper lip (or lower lip) skin area and under-eye skin will induce a healing process by the body which takes a few months to complete. In this time new collagen and elastin production occurs, creating newer smoother and tighter skin. Dr Omarjee recommends at least 3 Secret RF treatments in these areas for an aesthetic improvement to be achieved, spaced 1 month apart.

5. Platelet Rich Plasma (PRP)

Platelet Rich Plasma (PRP) is a natural treatment for improving skin texture and fine lines under the eyes and around the lower eyelid. It can also be used around the oral area for lines and skin texture rejuvenation. It uses your own plasma (with its healing and growth factors, called cytokines) to stimulate further production of collagen and naturally improve the look of your skin. Plasma contains a high concentration of platelets; that is, a specialised cell involved in injury healing and cell regeneration. The plasma is derived from a simple blood test, and then the blood is placed (in a test tube) in a special centrifuge to separate red blood cells from the plasma. The plasma is extracted into syringes and is then immediately ready to inject in the skin for rejuvenating benefits. The great thing about using your own plasma is that it contains your own natural growth factors and stem cells that encourage a refreshed appearance. PRP is also has a very low risk profile. The main side effects with the use of PRP injections is bruising and localized swelling, which usually resolve over a few days. Rarely infections can occur.

Dr Omarjee usually uses this treatment in combination with other treatments such as Erbium 2940nm ablative laser resurfacing or Secret RF micro-needling. But it can be used as a standalone treatment to improve the skin texture in the under eye and peri-oral area. If the latter is desired, one would need several treatments performed usually at 1-month intervals apart.