Injectable Techniques Used to Treat Smile Lines and Cheek Wrinkles

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Smile lines, or laugh lines, are the noticeable lines that form between our noses and our mouth. These lines get deeper as we age and are one of the first places we can see deep wrinkles forming, especially when we smile, which is why we tend to notice them more in photos. 

“Smile lines don’t make us smile!” says Miami dermatologist Diane Walder, MD. “There are two components to smile lines: the creases that form from repetitive motion and the loss of elastic and fat in our cheeks making it appear as if we have a heavy fold of skin.” 

Another area we start to see wrinkling in the face are small lines that form on our cheeks. “Radial cheek lines or ‘ripples’—like what you see when you skip a stone across a pond— are typically caused by volume depletion with photodamage. These do not disappear with animation and typically worsen with smiling,” explains Spokane, WA dermatologist Wm. Philip Werschler, MD.

To treat these areas, expert injectors say that replacing lost volume is the name of the game. “You start with adding diffused volume with a bio-stimulatory filler which will grow the facial collagen mask and thus ‘re-inflate’ the mid-face,” says Dr. Werschler. Dr. Walder notes, “We inject the lateral cheeks with a stiffer filler, like Voluma or Lyft, along the bone to lift that fallen shin.”

If the lines remain at rest, Dr. Werschler advises then partially filling them directly with hyaluronic acid fillers, which can help counteract the downward migration of the cheeks. “We then inject more superficially with a softer filler, like Refyne, along with those etched in lines,” says Dr. Walder. “If you inject too much filler in these folds it will actually make those folds look worse.”

A qualified injector will know which approach is best suited for your particular needs. How much product is used and where it is injected should be customized for each patient. “You have to proceed with caution because if you overcorrect you may end up with elevation of the lines with animation, which is sometimes called ‘hillocks’ that look like swollen lines,” adds Dr. Werschler.

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