Smoker's lines above the lip: causes and treatment options

Smoker's lines are the fine vertical lines that form above the upper lip. They are also called barcode lines or lipstick lines, because lipstick can bleed into them. Despite the name, many people who have them have never smoked. Here is why they appear, which treatments help at each depth, and what you can reasonably expect, whether you live on the Costa del Sol all year or spend the season here.

What smoker's lines are and why they appear

The lips are surrounded by a ring of muscle, the orbicularis oris. Every time you purse your lips, speak, drink or kiss, it pulls the skin of the upper lip into small vertical folds. When the skin is young and thick, it springs back. Over the years it does so less well.

Several things combine. The skin of the upper lip is thin and loses support with age. The bone and soft tissue around the mouth change shape. Sun exposure damages collagen, and so do some habits ^[1]. The result is a set of lines that first appear only with movement and, later, stay visible at rest.

Smoking does make a difference. In a study of 79 pairs of identical twins, the twin who smoked had worse upper lip wrinkles than the twin who did not ^[2]. Because twins share their genes, this points to smoking itself rather than inheritance.

Smoking is not the whole story, though. In another study of 143 adults, the severity of perioral lines was predicted by age, by being female and by years of smoking ^[3]. So a non-smoking woman with fair skin and plenty of sun behind her can have them too. Skin type and family tendency also play a part.

How you are assessed

The first question is depth. Your doctor looks at the lines with your mouth relaxed and while you purse your lips, in good light. This tells them which of three broad patterns you have:

• Dynamic lines, seen only when you move your mouth.
• Fine lines at rest, shallow and visible without movement.
• Etched lines, deeper grooves where the skin itself has changed, often with rough texture or sun damage.

They also check the volume of the lips and the length of the upper lip, because a thin or lengthening upper lip makes lines more visible. You will be asked about cold sores, previous filler, smoking, sun exposure and any medicines that make you bruise easily. Any sore or rough patch that does not heal is checked before cosmetic treatment is considered.

Treatment options by depth

Very fine hyaluronic acid, placed superficially

For fine lines, the usual first option is a very soft, low-viscosity hyaluronic acid gel. It is placed just under the skin, in tiny amounts along each line, rather than deep in the lip ^[4]. The aim is to support the skin and improve its hydration, not to add bulk.

This approach has trial evidence behind it. In a randomised trial of 280 people treated for the lips and the area around the mouth, the improvement in perioral lines with one of the soft gels lasted up to 12 months ^[5]. Results vary with the product, the amount and your skin. If you also want a little more definition of the lip itself, that can be planned at the same time; we explain it in our guide to lip filler.

Low-dose neuromodulators around the mouth

When the lines are mainly dynamic, a neuromodulator can soften the pull of the muscle. Very small doses are placed at a few points along the upper lip. How the muscles of the lower face move varies widely from person to person, and even between the two sides of the face. A small excess is tolerated far less well here than in the upper face ^[6].

The dosing has to be careful. The same muscle lets you speak clearly, drink, whistle and hold food in your mouth. Too much can make it harder to drink through a straw, whistle or pronounce some sounds until the effect wears off. For this reason the doses are kept low, and this option is not suitable for everyone. Singers, wind instrument players and people who speak for a living should mention it at the consultation. Read more about how anti-wrinkle injections work in general.

Used alongside filler, a neuromodulator can reduce the movement that creates the lines and help the filler result look smoother ^[4].

Resurfacing for etched lines

Deep, etched lines are partly a change in the skin itself. Filler alone tends to sit under them rather than erase them. Here, treatments that renew the skin surface and stimulate collagen come in: microneedling, with or without radiofrequency, fractional lasers, fully ablative lasers and, less often, deeper chemical peels ^[7].

These differ mainly in strength and downtime. Microneedling and lighter options need several sessions but have a short recovery. Ablative lasers can achieve more in fewer sessions, with more redness and a longer recovery. Our article on microneedling explains what a course involves.

Combining treatments

There is no agreed single technique for perioral lines. A review of the options proposed combining them, matched to your goals and the downtime you can accept ^[7]. In practice, that often means resurfacing to improve the skin, soft filler for the lines that remain, and sometimes a low-dose neuromodulator for movement.