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Antiwrinkle Injections for Smokers Lines / Lip Lines

Author: Dr Naomi / 28 Oct 2015

Dermal fillers are the best treatment for smokers lines and lip border and lip lines. However, in some patients, it is worth adding some muscle relaxing injections to prevent the lips being pulled in together causing those vertical lines. Antiwrinkle injections can be used to treat the lip lines (due to Australian regulations, we are not allowed to name the drugs)
Sometimes smokers lines are genetic, and will run in a family.
Small injections with a very fine needle are used to relax the muscle on the upper lip
The consultation for muscle relaxing injections for smokers lines
History-taking  is very important in the treatment of smoker’s lines. The following should be explored:
Is there a genetic component? ie are there others in the family who have deep smoker’s lines
Has the patient had treatment before?
Were they happy every time?
Did the effect of the muscle relaxing injections last well?
Which area came back first?
How is the patient’s metabolism? Do they exercise? Are they very muscular? Do they have trouble putting on or losing weight?
Have they every had any complications with muscle relaxing injections of the perioral lines before, including difficult with speaking, eating, drinking through a straw, kissing and smoking
Does the patient want a more natural appearance, or do they want the maximal effect possible?
What is the age of the patient?
Have they used or are they going to use filler in their smoker’s lines as well

The examination
The doctor will examine the lips. In particular, she will look at many features, such as:
When the patient talks, do they pull the lips in causing smoker’s lines?
Whether there is an asymmetry

Choosing the dose of toxin
The doctor will assess the lips and decide on the best dose after taking a history and examining the patient.
If the patient has a history of poor longevity, or needing high doses or wanting maximal effect, then a higher dose may be suggested
If a patient has a history of complications with muscle relaxing injections, or if their budget is small or if they want a more subtle result, then a smaller dose might be chosen.

Pain relief during treatment
A numbing cream (eg EMLA or LMX ) may be applied to the area prior to the treatment (45 minutes prior is ideal) Glad wrap may be used over the numbing cream to increase its effect.
Most patients do not bother with numbing cream because it takes so long to work and because the treatment is very quick.
Ice is always used to decrease pain and to reduce the risk of bruising.

Nitrous Oxide (Happy Gas) is available for use with injections
Very rare patients will use Penthrox for smoker’s line / lip line treatments

What happens during the smoker’s line treatment itself?
The mouth area will be cleaned with alcohol.
Ice will be applied to the area briefly before treatment
The doctor will inject approximately 4 sites near the lip. Then pressure with gauze will be applied.
The procedure itself takes less than 5 minutes.

How do I look afterwards?
Sometimes there is nothing to see. Sometimes there can be redness, small lumps, which can look like mild acne and usually resolve quite quickly.
Most people could come during their lunch break during work and go back without their coworkers noticing anything
Typical problems which can occur:
In general, treatment of the lip lines is low risk.
Headache happens in around 10% of new users.
Bruising occurs in a significant number of cases.
Asymmetry: Often one side is better treated than the other, this is usually because the patient is asymmetrical to start with. In some patients they have a much stronger muscle on one side compared to the other. If a smoker, often the worst side is the side they use for a cigarette
Infection is a very rare complication, but always a possibility when the needle goes into the skin.
There is a low risk of the speech being affected, also the patient may have difficulty with smoking, drinking through a straw or eating if too high a dose is used

Who is unsuitable for treatment for of smokers lines with muscle relaxing injections?
Most people are suitable for this treatment, but patients should always also consider dermal filler to treat this area

Instructions for care afterward
No makeup for 4 hours
No massage that day
No heavy exercise that day
No lying down for 4 hours
Lay off the acid face products for 24 hours

What to expect after smoker’s line / lip line treatment?
The effect of the injections will start to occur after 2-8 days.
The maximal effect of the drug will be at 3-4 weeks, so a review should be booked for 3 weeks. If at that time, further treatment is necessary, it should be performed.

What if I get asymmetry at some time before the 3 week point? Do I call the doctor?
No. No need to call the doctor. Sometimes asymmetry will occur because one side just comes on quicker than the other. Usually it will right itself by the time of the review appointment. If it doesn’t, then it can be treated at the review appointment. There is no point in coming in early for treatment of asymmetry.

What do I do if at 3 weeks post treatment one side is better treated than the other?
This is not uncommon, at your 3 week review appointment, further treatment may be administered.

How long will the treatment last?
The answer to this is very individual and depends on the patient’s metabolism, the dose, the placement etc.
Typically this is what happens:
At 4 weeks, there is a maximal effect
at 8 weeks, movement starts to return
at 12 weeks, 50% of movement should be back
at 16 weeks 80% of movement should be back.
For most patients, this is very close to what occurs.

When should I have my next treatment for muscle relaxing injections in lip lines?
Patients should be retreated when the movement is between 50%-80% back ie sometime from 3-4 months

Some patients choose to have treatment after 8 weeks

How much does it cost for the muscle relaxing injections in smokers lines / lip lines?
$260, it will cost less if combining with other area

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