Smile lines are wrinkles or folds that occur between the nostrils and the corners of the mouth. These lines, also known as parentheses, typically start showing up in our 20s and 30s when our collagen production slows down and the skin becomes thinner.
Fortunately, collagen loss and the appearance of these lines can be delayed by maintaining a healthy lifestyle, avoiding excessive sun exposure and smoking, and keeping the skin well hydrated.
There are also clinical and non-clinical treatments – as well as topical creams and lotions – that can help diminish smile lines, ultimately resulting in a more youthful appearance.
With so much advice currently offered on this topic, this article provides a comprehensive look at treatments and products that really work, according to experts. On the flipside, we also include methods that don’t work, so you know what to avoid when it comes to spending money.
We’ve gathered input from three top medical experts, as well as other sources, to give you best options to treat your smile lines.
Let’s begin with an overview of smile lines and what causes them. Then, we’ll discuss numerous clinical and non-clinical options that you can choose from based on your specific needs.
What Are Smile Lines?
Smile lines are wrinkles that occur when we smile.
In younger people, the lines disappear after smiling, but in older men and women, these lines remain even when the face relaxes, said Dr. Yuly Gorodisky, owner of the West Coast Plastic Surgery Center in Southern California who is board-certified by the American Osteopathic Board of Surgery.
Lines start showing up in the 20s and 30s in most people, he said, because this is the time when our collagen production typically slows down and the skin gets thinner.
“This causes the lines to become more permanent and harder to treat,” Dr. Gorodisky noted. “Some patients who have thicker skin take longer to develop lines and they may not appear until later in life.”
Smile lines are also known as nasolabial folds, which are the grooves that develop around the mouth and extend up to the nose and are accentuated with smiling, explained Dr. Kally Papantoniou, a cosmetic dermatologist who is board certified by the American Board of Dermatology.
In cosmetic dermatology, one of the most common areas that patients request treatment is for the smile lines, noted Dr. Papantoniou, who specializes in injectables, lasers and surgical and general dermatology.
“Most people will notice their smile lines in photographs, and they feel that this feature makes them look tired, older, and weathered,” Dr. Papantoniou said. “It is one of the first noticeable changes that occur, so will often be the first thing that is sought out for correction.”
The majority of people who want to improve their smile lines feel like their skin does not represent how they feel, said Nina Copeland, a dermatology nurse practitioner at Johnson Dermatology, one of the largest laser centers in the state of Arkansas.
“Most of us want to look in the mirror and see our inner beauty radiating out,” Copeland said. “We all wish to feel young and refreshed and represent that in our appearance. Most commonly I hear ‘I look older than I am,’ or ‘I feel unhappy when I see pictures of myself’.”
Now that we’ve explained what smile lines are, let’s take a closer look at what causes them.
What Causes Smile Lines?
Some lines around the mouth are etched into the skin from the muscles that move when we smile, Copeland explained, and the lines we make in motion over time develop into lines at rest.
As we age we often lose volume in the mid-face which drops to around the oral area, she said, which results in deep nasolabial folds, marionette lines and jowls.
“Although some of this is age related there are other factors that effect at what age we develop lines,” Copeland noted. “These include sun exposure, tanning bed use and genetic predisposition which makes it very difficult to give an exact age at which these lines develop.”
Volume loss in the fat pads of the mid-face results in the descent of skin and contributes to the deepening of the nasolabial fold, Dr. Papantoniou said. Other contributing factors are the loss of skin elasticity, and the breakdown of collagen and elastin fibers, which can result in sagging skin.
“These changes occur with aging, and can start to occur as early as age 25, but will vary depending on lifestyle and genetics,” said Dr. Papantoniou.
The lines are associated with advancing age and those who present for treatment are usually confronted by the inevitability of aging and the visible signs that their body is changing, Dr. Gorodisky said.
“They want to return to the smooth skin of their youth,” he noted. Ultimately, “The lines need to be evaluated and the cause of the lines determined…a consultation with a plastic surgeon can help determine the best plan of treatment to improve and maintain the aging skin.”
As we age, we lose a multitude of traits such as a decrease in skin elasticity, volume in the face, and bone mass, according to Nina Luong, a physician assistant and primary aesthetic provider at Finesse Plastic Surgery in Southern California.
“As the skin becomes thinner and loses its elasticity, facial structures will start to slowly fall and show signs of aging including smile lines,” Luong said. “Due to the decrease of facial fat and the shrinking of the facial bones, it causes significant volume loss. This causes the face to appear more saggy and emphasizes the smile lines.”
10 Best Clinical Treatments for Smile Lines
Now, let’s take a look at several clinical treatments that actually work to treat smile lines, according to our experts. But before you decide to pursue any clinical treatment, it’s important to consult with your physician first.
1. Botox, Dysport and Xeomin
In Dr. Gorodisky’s practice, the most common treatments are directed toward limiting the wrinkling of the skin around the eyes during smiling.
This is done using injectable treatments such as Botox, Dysport, and Xeomin. This lasts about 3 to 4 months and can cost around $250 to $300 for each treatment.
The most common side effect is a small temporary bruise in the area of injection, but the treatment is very effective in most patients.
2. Juvederm or Restylane
For the area around the mouth, the lines are filled using an injectable filler such as Juvederm or Restylane. This costs about $550 to $1,100 or more, depending on how many syringes of filler are used. The treatment also has a potential side effect of bruising and swelling and lasts for about 9 to 12 months.
According to the Food and Drug Administration, Restylane Lyft with Lidocaine is a hyaluronic acid gel that is injected into moderate to severe facial folds and wrinkles. This may help smooth the appearance of moderate to severe smile lines.
The FDA also noted that Juvederm Vollure XC has been used to correct moderate to severe facial wrinkles and folds, such as nasolabial folds, in adults over the age of 21.
3. Evolence® Collagen Filler
The FDA has also approved Evolence® Collagen Filler, which is injected into the inner layers of facial skin to correct moderate to deep facial wrinkles and folds, such as nasolabial folds.
These injections typically cost from $500 to $700 per syringe, and you may need one or more depending on your specific needs. Additional costs may include surgeon fees, which differs from practice to practice.
Hylaform gel is sterile and colorless dermal filler made of chemically modified hyaluronic acid derived from a bird source, according to the FDA.
This FDA-approved product is described as a naturally occurring substance found in cell and tissue fluids that is chemically, physically, and biologically similar in the tissues of all species.
Hylaform works by temporarily adding volume to facial tissue and restoring a smoother appearance to the face, and the effect lasts for about 12 weeks. Some average costs range from $300 to $500 for a single Hylaform session, according to the DermaNetwork.
5. Chemical Peels, Plasma, Laser, Radio Frequency and Microneedling
Other more invasive options that Dr. Gorodisky performs include chemical peels, plasma, laser, radio frequency and microneedling, which physically stimulate the collagen production and skin tightening by causing various degrees of injury to the skin, and creating tighter skin through natural repair mechanisms.
These treatments can vary in cost from $200 to $2,000 and may have minimal to several weeks of downtime.
“There are also surgical options that lift and tighten the skin that can cost $5,000 to $10,000 and although are more invasive and have longer healing time, may achieve more effective and longer lasting results,” Dr. Gorodisky said.
6. Hyaluronic Acid Fillers
In Dr. Papantoniou’s practice, dermal fillers tend to work the best for smile lines.
“Hyaluronic acid fillers are the most popular injectables used for this area and can work very well,” she said. “Depending on how many syringes are required, the price may vary from $600 to over $1200, and usually will last about 1 year in this area. Dermal HA fillers very rarely have any side effects if injected by an expert injector, however if not properly injected important vessels can become blocked.”
If smile lines are due to volume loss, hyaluronic acid fillers can help volumize those specific areas, Luong noted.
At Finesse Plastic Surgery, “I will add cheek fillers to help pull the laugh lines upwards and make it appear less heavy,” Luong explained. “A syringe of filler costs $600 or more depending on the type of filler that is used. Most patients will need at least 1 to 2 syringes to improve the area and the results can last 1 to 2 years.”
7. Silhouette Instalift
The Silhouette Instalift is a newer technique that lifts the mid-face and minimizes the nasolabial fold.
“This involves the use of absorbable sutures that are no larger than the size of a needle,” Dr. Papantoniou said. “With minimal recovery, possible bruising, the Instalift is gaining popularity due to the natural look and longevity of results, which can last up to 2 years.”
Silhouette Instalift can range in price from $3,500 to $6,000, and will depend on the number of threads used.
8. Microneedling or Fraxel Dual Laser
Microneedling or Fraxel Dual laser may be helpful for etched smile lines. This can take 3 to 5 sessions, and usually the cost will start at $500.
“This works by creating controlled injuries with a microneedle or laser light, stimulating skin to heal and produce collagen in the treated areas,” Dr. Papantoniou explained. “Recovery is minimal, slight redness immediately after, but the next day most patients can go back to work and apply makeup.”
9. Ulthera and Thermage
Dr. Papantoniou recommends tightening energy devices such as the Ulthera, which works with ultrasound to help lift and tighten skin, minimizing the smile lines. Additionally, Thermage is an energy-based device that uses radiofrequency to stimulate skin tightening and new collagen.
When it comes to exploring the best clinical treatments for smile lines, Copeland offered the comparison of the skin to your bedding at home.
“You have your mattress which gives your bed structure, that's what we use filler for,” Copeland said. “Your sheets are in between the mattress and the comforter. That's where we use lasers.”
Lastly, the comforter is the very top layer, and you have to pull it up every day. “This is where we need topicals.”
“In relation to your results, you will have good, better or best,” Copeland said. “Good if you just get a mattress, better if you have a mattress and sheets, and the best if you have all three.”
Some people may just need topical, some just lasers, some just injections and some a combination.
“This is why it is so important to go to a core specialty injector that specializes in cosmetics for a personalized consultation and plan,” Copeland added. “What one person needs for smile lines may be completely different than the next person. Some people may only spend $75 and some may spend $10,000.”
Radiesse, an injectible for facial folds and wrinkles, is used to fill moderate to severe wrinkles and folds, including nasolabial folds, according to the FDA. Although Radiesse will not correct the underlying causes, this injectible immediately adds fullness to your face, giving you a visible result at the first treatment session.
Although treatment effects differ for each individual, Radiesse lasted up to six months in a clinical study. Common side effects may include redness, bruising or swelling, and generally last for a short time.
The average cost for these injections is around $1,000 per treatment, not including additional fees such as anesthesia. Prices can differ depending on each practice, so talk to your doctor about pricing in your area.
While there are numerous clinical methods that treat smile lines, there are also non-clinical methods, which we cover in the next section.
Natural Treatments for Smile Lines
Copeland always tries to remind people in search of a natural treatment that natural is not always better for the skin.
“For example, poison ivy is a plant but it still causes a rash,” Copeland said. “Coconut oil is a moisturizer with anti inflammatory properties but many people develop an allergy to it with repeated use.”
1. Prevent Premature Photoaging
The best natural thing you can do for your skin is to prevent premature photoaging by wearing sunscreen and sun protective clothing, Copeland advised.
“Look for a physical sunscreen with zinc oxide or titanium dioxide rather than a chemical sunscreen,” she said.
2. Maintain Healthy Lifestyle Choices
Laugh lines will occur for most of us through the aging process; however lifestyle choices may have a strong impact, according to Dr. Papantoniou.
“A healthy diet, no smoking, and no great weight fluctuation will be helpful for preventing deep smile lines,” she said.
Dr. Gorodisky agreed that avoiding excessive sun exposure and smoking, and keeping the skin well hydrated, can delay the collagen loss and delay the appearance of the lines.
Not just smile lines – but all fine lines and wrinkles – will develop at a lesser degree with good skincare, Copeland added.
“At the very least I recommend sunscreen every morning and retinol every night,” she said. “Always being sun smart is very important as well. Wear your sun protective clothing, avoid the hottest parts of the day and seek shade.”
Living a healthy lifestyle and avoiding sun exposure to the face will definitely help prevent the laugh lines from coming sooner, Luong said, “however, the smile lines are a normal part of aging.”
Best Lotions and Creams for Smile Lines
Other non-clinical ways to diminish laugh lines are the use of certain lotions and creams. Here’s the list of best creams for smile lines, according to our experts.
1. SkinMedica Tissue Nutrient Solution and HA5
For etched in smile lines, Copeland likes to combine SkinMedica TNS essential serum and HA5.
“The HA5 works on the top layer of your skin called the epidermis immediately plumping it and increasing collagen over time,” Copeland explained. “The TNS essential serum has growth factors that build collagen in the dermis which is the deeper layer of skin. These two together are a powerhouse for topical skin tightening.”
2. Hyaluronic Acid Serums and Moisturizers
Dr. Papantoniou recommends the use of topical hyaluronic acid serums and moisturizers that work to plump and smooth finer lines.
“Using a retinol cream will also help for etched lines and may be mildly helpful,” she advised.
3. ZO Skin Health Products
Dr. Gorodisky usually recommends products from the ZO Skin Health line, in addition to injectable treatments using fillers and Botox. ZO Skin Health was created by Dr. Zein Obagi, a world-renowned skincare expert who has authored several best-selling books.
“A combination treatment works better than either treatment alone,” Dr. Gorodisky said.
At Finesse Plastic Surgery, ZO is very well liked by patients who notice a big difference after using the regimen for 4 to 6 weeks, Luong said. She recommends trying the starter kit, which includes a daily DNA repair cream, exfoliator, retinol and sunscreen.
“The daily DNA repair cream speeds up the skin’s natural mechanism to repair damaged DNA and protect against future oxidative damage,” Luong explained. “This promotes the cell turnover rate and provides a more even skin tone.”
Retinol has been around for many years and is a great anti-aging product, Luong added.
“Retinol stimulates collagen and helps diminish fine lines/wrinkles. It also improves pigmentation, helps smooth skin texture, and firms the skin,” she said.
4. Vitamin A Skin Care Products
Other non-medical treatments in Dr. Gorodisky’s office involve hydration and stimulation of the skin to produce more collagen. This includes vitamin A derived skin care products which may be prescription or non-prescription strength.
While many methods and products are claimed to treat smile lines, there are many things on the market that don’t work, according to experts. The following section covers what to avoid.
What to Avoid When Treating Smile Lines
There are many treatments that claim to work, and they may improve the appearance of the lines temporarily due to hydration of the skin and tightening effects, Dr. Gorodisky noted.
“Most effects are short acting unless the treatment helps to repair the skin and stimulate collagen thickening,” he said.
Do not expect a topical cream or lotion to provide the corrective results that come from fillers, Dr. Papantoniou advised.
“It is better to not waste time and money on these products if you are looking for significant results,” she said.
Copeland recommends avoiding drying toners and scrubs on your skin.
“These things will cause irritation and inflammation of the skin making it appear dull, dry and quite frankly shriveled up,” she said.
“Any product that promises it will eliminate smile lines completely is a sham.”
Copeland also advises people to save their money on moisturizers and cleansers “as they are just water and oil.”
“Although hydrated skin is happy skin you can do that with a plain white moisturizer from your local dollar store,” Copeland said. “Put your money into ingredients that are scientifically proven to change your skin such a retinol. Adapalene gel 0.1% recently became over the counter and is a great option. I also encourage you to avoid gimmicky products such as masks and roller devices.”
Any product that promises it will eliminate smile lines completely is a sham, Luong added.
“Treating smile lines is a multidimensional approach and no single product can do it all,” she said.
Final Thoughts on How to Get Rid of Smile Lines
Everyone should be treated according to their individual needs, because what works for one person may not be what the next person needs, Copeland advised.
“Who you pick to trust with your skin needs is very important. You should like the way their skin looks and be able to communicate with them effectively,” she said. “Basically, don't get your advice from a social media poll. Sometimes spending the time with a dermatologist will save you thousands of dollars on products that just don't work.”
The way to address them may include different modalities including skin care and rejuvenation, limiting wrinkling by relaxing the muscles responsible for the wrinkles, and adding volume to the wrinkle to smooth it out, Dr. Gorodisky noted.
“Additional therapies may include laser treatments to stimulate skin repair and turn over as well as surgery to lift and tighten sagging skin,” he said.
The bottom line is, most of us are going to get smile lines, and we have great ways to treat and reverse them, Dr. Papantoniou said.
“First thing most people will try is a filler, and then if more lifting is needed it would be good to employ a tightening treatment for added benefit,” she advised. “It is important to use a combination of therapies to treat deeper lines for a more natural look, to ensure that we do not look over-filled.”
The bottom line is everyone is going to have smile lines at one point in their life, Luong added.
“It will take some years before the lines bother them enough to seek treatment,” she said. “Once you are ready, I suggest seeing a provider in plastic surgery or dermatology that specializes in facial aesthetic treatments.”
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