These types of wrinkles are generally referred to as "perioral"  lines (peri means around, oral stands for mouth) because they are located around the mouth. They occur naturally due to normal  facial expression of the perioral muscles. Everyone will eventually develop perioral lines over time because they are formed due to normal everyday facial expressions of the mouth. At an old age, perioral lines (or smoker lines) may not necessarily be caused by tobacco smoke; smokers just develop them much earlier,  the wrinkles become much deeper and more unsightly. Hence perioral lines are usually referred to as smoker lines because they are highly accentuated in heavy smokers.  Perioral lines are just deeper and more unsightly in heavy smokers who develop them earlier and faster than non smokers (to read two interesting articles about the damage caused by cigarette smoke please click here and here). Women are particularly are self conscious of their perioral lines and sometimes, women also seek aesthetic perioral lines attenuation treatments, even if they are non smokers. Heavy smokers over 60 years of age  usually have particularly deep and sometimes unsightly perioral wrinkles. Smoker lines these may be challenging to fix because sometimes they can be particularly deep,  however there are many aesthetic treatments available to improve their appearance. It is important to emphasise that no aesthetic treatment can guarantee the complete disappearance of these lines as any expression wrinkle can be attenuated (even significantly) but never removed unless the facial muscles movements are impaired both intentionally (using botox toxin) or unintentionally (due to medical conditions).

Although they can seem quite challenging to treat, there are several solutions for perioral lines attenuation. There are permanent and non permanent solutions. We will explore the non permanent solutions first and the permanent solutions after. Temporary solutions Non permanent treatments to attenuate perioral or smoker lines are accomplished through the use of Botox injections or fillers, alternatively a combined treatment of both. Botox treatments have the effect of reducing the facial muscle  movement that causes the perioral lines in the first place. However, the effects of Botox are temporary and this treatment requires to be repeated over time. Also fillers are used in order to fill the recess of the wrinkles themselves. Like Botox, fillers are not a permanent solution and they will get reabsorbed over time. This means that the treatment has to be repeated every time the filler has been reabsorbed. Permanent solutions The main principle behind permanent aesthetic solutions for perioral lines attenuation (also referred and advertised as smoker lines removal) is skin regeneration (collagen regeneration/ stimulation) and skin tightening. Although some of these treatments may be incorrectly advertised as surgical procedures, by definition they all are aesthetic non surgical treatments. As it is well known collagen regeneration and skin tightening can be accomplished in several ways. For example using:

• Laser resurfacing.
• Electrical arcing.
• Micro needling.
• Cosmetic peels.
• Micro dermal abrasion.

Although the focus of this web page is the use of Voltaic Arcing (Plasma) for perioral lines attenuation, we will touch briefly on each of the aesthetic treatments available for smoker lines attenuation. The following video provides a good overview of the approach which can be taken in tackling perioral lines by the professional aesthetic practitioner.

Lasers treatments have very effective skin resurfacing and skin tightening  properties. Therefore they have been used over several years for perioral lines attenuation . Both Fraxel and CO2 lasers are normally used for this application in aesthetic clinics. Although they are sometimes referred to as surgical methods for marketing purposes, they are clearly non invasive non surgical procedures.  Like in laser tattoo removal, a certain degree of bleeding can occur during these aesthetic treatments. Bleeding is a minor occurrence and it is temporary. This stops immediately after the treatment has ended because the minor bleeding is caused by broken superficial capillaries. Redness immediately after the treatment lasting up to 24 hours is a normal reaction to this type of aesthetic treatment using aesthetic lasers. The day following the treatment redness is followed by swelling caused by the burn induced by the laser treatment itself. The degree of swelling is proportional to the intensity of the treatment and it peaks the third to fourth day after the treatment. As the swelling subsides a scabbing/peeling process usually takes place. The scabbing can last up to 7 to 10 days after the aesthetic treatment depending on the intensity of the aesthetic treatment and the particular skin reaction. Both swelling and the peeling effects disappear on their own accord without the use of any medicines or medication. The downtime of this type of treatment varies between 6 to 10 days depending on the type of treatment and the particular skin reaction.

Micro needling has the notorious effect of collagen stimulation. Micro-needling reduces the appearance of fine lines including perioral lines as a stand alone treatment. There are also devices devices which combine micro needing with micro currents used to heat up the skin. This has a double collagen stimulation not only through the micro injury caused by micro needling but also due to the micro-current injected into the skin. Furthermore there are other micro needling devices which inject skin rejuvenation substances through the skin.

AHAs (Alpha Hydroxy Acids) based products have well known collagen stimulation regeneration properties. These properties make AHA based cosmetic peels excellent products to reduce the appearance of fine lines and also perioral lines attenuation.  There are several AHAs  options for cosmetic peels suitable for this type of aesthetic treatment the most popular is glycolic acid, however there are several other options for this particular application including mandelic acid, TCA based products etc. One of the main disadvantages of this aesthetic solution is that  several treatments may be required in order to achieve the best possible results. By contrast, the main advantage is that they are relatively inexpensive because they are widely available on the market and they can sometimes be used at home and not only in an aesthetic clinics, making this a very convenient home based aesthetic treatment.

Significant improvements in the appearance of  perioral lines can be also be achieved by using microdermabrasion treatments. By "sanding down" the skin around the perioral area They lessen the uneven pigment and brighten the skin around the mouth, thus improving the textural appearance of the skin around the mouth. Brighter, lighter, more evenly coloured skin looks smoother and less wrinkled because it throws more light. Done right, these superficial treatments may also stimulate a little new collagen formation in the superficial dermis to help structurally reverse wrinkles too.

Over the years Voltaic arcing (also referred to as Plasma or Micro Arcing) has been used extensively in perioral lines attenuation with very good results. As you will see in this section this aesthetic procedure is safe and extremely easy to perform.  It is recommended to advertise this aesthetic treatment as perioral lines attenuation, instead as perioral lines or smoker lines  removal. Although some clinics may advertise this type of treatment with voltaic arcing devices as perioral lines removal or smoker lines removal this is best to be advertised as perioral lines attenuation as there is a mild improvement in the appearance of these lines after each treatment. With electrical arcing the aesthetic treatment attenuates the perioral lines by "pulling" the area between the wrinkles taking advantage of both collagen regeneration and localised skin tightening. Therefore, strictly speaking, Voltaic plasma cannot remove completely the vertical expression lines. With the "pulling" effect induced by the localised skin tightening, the the wrinkles become less and less visible after each treatment. The best candidates for this procedure are women over 60 years of age who have been heavy smokers because, not only are they particularly motivated to have these wrinkles removed, but  their vertical smoker lines are usually quite deep hence easily attenuated using electrical arcing (plasma).  Therefore  older women who have been smoking all their lives are usually very satisfied with the results achieved using this type of aesthetic treatment. By using Electrical Arcing you apply the same localised skin tightening techniques which allow wrinkle attenuation around the perioral lines or at the edges. You can either use the spot mode or the spray mode for this type of localised skin tightening. The first time you attempt this aesthetic procedure using any or our devices, set the unit at minimum power level and apply the spots in a random fashion, with an instantaneous duration (one quarter of a second), and distancing them between 3 to 4 mm apart. As you gain experience with this type of treatment you can increase the intensity of the treatment by first decreasing the distance between the spots. Some experienced users move towards the spray operation as they gain experience. In the video below we can appreciate an example of mild (low treatment intensity) for perioral line attenuation using electrical arcing. Our electrical arcing device was used at minimum power level. The aesthetic procedure in the video below is deliberately fast-forwarded. As you can see the beauty therapist in this case has removed only the part of the topical numbing product required to allow the treatment. Where the treatment is not being carried out the numbing product is still applied. It is highly recommended to only remove the topical numbing product in small patches to ensure the area you are going to treat is still numb at the time of the treatment. A common mistake made by beginners is to remove all numbing product all at once. Depending on the product used, the numbing effects maybe relatively short lived, therefore if the area to be treated is relatively extensive, the effects of the numbing product may have faded by the time you can treat area which previously had the numbing product applied on it. Treating an area while it is not numb can make the treatment rather uncomfortable to the client. For more information about the use of numbing products before this procedure please click here. In the video below we can see the same procedure at normal speed. It is clear that the treatment is deliberately superficial (low intensity treatment). This is because the effects of the localised skin tightening do occur even when the arc has been applied very superficially (low intensity treatment). It is always advisable to apply the arc superficially when first performing localised skin tightening using plasma. It is far better to perform the treatment at low/medium intensity rather than using high intensity treatments. As as explained in the skin tightening section the intensity of the treatment is not directly proportional to the skin tightening effects; rarely high intensity treatments are recommended for this aesthetic application. Therefore when in doubt, always apply the arc ensuring to be carrying out a very mild/medium intensity treatment. The treatment can then be repeated as required to achieve the desired results. Those who live a healthy lifestyle also develop some form of perioral lines over time, however they are very easily attenuated due to the fact that there is no extensive skin damage caused by the oxidation effects of carbon monoxide in cigarette and tobacco smoke. In the video below we can see an example of perioral lines attenuation treatment using plasma on a non smoker. In this case the client had made clear her intention to attenuate her very mild perioral wrinkles. Normally, the beauty practitioner would not intentionally advice this treatment to non smokers as their perioral lines are superficial and normally other aesthetic treatments using electrical arcing may be preferred such as Eyelid Tightening. However should the client expressedly request this treatment you can go ahead and perform it using low intensity treatments as demonstrated in the video below. The Beauty therapist in this case used a mild spraying technique. The device used was set at minimum power level.  As you see in this short clip the fulguration is applied very superficially in short spraying bursts.  Remember that the minimum power level of our electro fulguration devices are meant to be used for all the aesthetic treatments, it is especially recommended for beginner level. In the video below we can see another example of a mild spray operation for smoker lines attenuation. The spraying motion is applied on the borders of each line. This is a mild intensity treatment.

• Apply the usual procedures before this type of aesthetic treatment such as screening the client, patch testing, explaining the content of the consent form and apply the appropriate numbing product before carrying out this type aesthetic treatment. The pretreatment procedures are the standard ones which can be found in this link here.
• Use the spot mode or spot operation between the perioral lines and not inside the lines themselves. When performing this type of aesthetic treatment for the first time apply the spots randomly distanced 3 to 4 mm apart, use apply the spots in a random fashion, with an instantaneous duration (one quarter of a second), and distancing them between 3 to 4 mm apart. As you gain experience with this type of treatment you can increase the intensity of the treatment by first decreasing the distance between the spots.
• Only use the spray mode or spray operation after you have gained confidence with performing these types of treatments. The user perform an epidermal superficial peel between the vertical wrinkles. Only some experienced users move towards the spray operation as they gain experience; most aesthetic practitioners prefer using the spot operation as it easy to use and leads to consistent results..
• After this procedure has been carried out, the client has to look after the area appropriately until the scabs have fallen off on their own accord. The main after care required is the use of the appropriate antiseptic to reduce the likelihood of infections during the skin recovery process. Scabs may or may not develop depending on the skin type and how the treatment has been carried out (is spot mode they tend to develop where the ablation points have been applied , in the spray mode they be replaced by a mild peeling effect instead. ). The scabs, if they develop they will start to form two to three days after the procedure. The client has make sure to pro-actively avoiding infections, and avoiding picking the scabs which may form and do not use any type of cover up make up until the scabs have fallen off by themselves. To review this section please read the standard after care instructions.
• Treatment Downtime. The client can resume any of their normal professional activities immediately after this aesthetic treatment, however the client should purposely avoid any activities which can increase the exposure to potential infections. Normally redness occurs immediately after this type of aesthetic treatment.There could be some degree of swelling associated to this treatment.  However selling is a rare occurrence  and usually takes place after high intensity treatments and starts the day after the treatment peaking the third to fourth day subsiding on its own accord. On average the perceived downtime is 7 days and this varies according to the intensity treatment and the individual skin reaction.
• The treatment can be repeated every 4 to 5 weeks. Depending on the skin reaction to the treatment (ie the skin is still pinkish after 4 to 6 weeks) wait until the skin colour is normal before repeating the treatment
• Normally for deep perioral lines (smoker lines) 4 to 5 medium intensity treatments may be required in order to achieve satisfactory results.
• In case of mild perioral lines in non smokers one to two medium intensity treatments may suffice to achieve the desired results.

Although they maybe challenging to improve there are several aesthetic treatments available for perioral lines attenuation, some are temporary and others are permanent. Once the main "permanent" aesthetic treatment for perioral lines attenuation has been carried out successfully, you may want to delay its recurrence, this is done by tackling the two root causes of the perioral lines formation by

1. Reducing the muscle movements,
2. and delay the natural or induced (by smoking) Skin Oxidation (ageing).

The muscle movement cannot be impaired completely as it is necessary for normal daily activities, however appropriate Botox injections can help reduce the muscle action and eventually delay  the recurrence of the smoker lines. Therefore the periodical use of Botox can serve as a preventative treatment to try and delay the worsening of the perioral lines over the long haul. Skin oxidation can be delayed simply by quitting smoking, a balanced diet, reduce alcohol consumption,  avoiding exposure to UV light both from natural and artificial sources; also starting or continuing regular moderate physical exercise can be beneficial.