Botulinum toxin for vertical lines of the upper lip

The vertical lines above the upper lip, popularly known as "barcode lines" or "smoker's lines" (even in people who never smoked), are among the hardest concerns to resolve in HOF. The patient wants smooth skin and a natural lip, and the professional knows that each resource alone delivers only part of it. Botulinum toxin enters this picture as one piece, not as the answer.

This page presents, at review level, the role of the muscle, the limits of the toxin and care for function. There is no dose, injection point or technique. Management is the decision of the qualified professional, following the product label and the rules of their professional council in Brazil.

What causes vertical lines of the upper lip?

There is no single cause. In general, the picture results from several factors added together:

1. Repeated contraction of the orbicularis oris when speaking, smiling, drinking through a straw, whistling, smoking or playing wind instruments.
2. Loss of skin quality: thinning of the dermis, reduced collagen and elastin, with photoaging.
3. Loss of volume of the lip and surrounding tissue, which leaves the skin unsupported.
4. Skeletal and dental factors: bone resorption of the maxilla, tooth loss or loss of support, which change the relationship of the lip to the structure.
5. Genetics and skin phototype.
6. Smoking and other habits.

This multifactorial cause explains why the approach is usually combined. More on lip lines is in the glossary, under lip lines and in hyaluronic acid for lip lines.

Role of the orbicularis oris

The orbicularis oris is a sphincter that surrounds the lips. It closes the mouth, protrudes and purses the lips, and is essential for speech, suction, blowing, whistling and containing food and liquids. When contracted, its circular fibers form radial folds around the mouth.

This function explains both the advantage and the risk of toxin in this region:

• Advantage: reducing contraction can soften dynamic folds.
• Risk: reducing the sphincter's strength can affect everyday functions.

Neighboring muscles, such as the upper lip elevators and the depressors of the mouth corner, make up the dynamics of the smile. Acting on the orbicularis can interfere with them indirectly, a topic also discussed in frozen smile after toxin.

What the toxin does and does not do

In static lines, which persist with the face at rest, improvement with toxin alone is usually limited. These cases call for strategies aimed at skin quality and support, which may include superficial filler, biostimulation, microneedling, laser and dermatological care, depending on the indication and the professional's training. In heavily sun-damaged skin, the approach comes close to what is discussed in botulinum toxin in thin, sun-damaged skin.

Functional risks

Since the lip is a structure of function, the most important risk of the toxin is not aesthetic but functional. The main points:

• Difficulty pronouncing sounds that depend on the lips, such as "p", "b", "m", "f" and "v", and altered whistling.
• Difficulty using a straw or drinking liquids without leakage.
• Asymmetry of the lip or smile.
• Reduced oral competence, with leakage of saliva or liquid in cases of excessive effect.
• Change in wind instrument playing, relevant for musicians.
• A "limp" or expressionless lip appearance.
• Diffusion to neighboring muscles, with an altered smile. See toxin diffusion.

These effects are generally temporary and follow the duration of the toxin, but the impact on the patient's routine can be large.

Functional and aesthetic assessment

Before any decision, a two-part assessment is worthwhile.

Functional part

1. The patient's profession and habits (voice, blowing, straws, smoking).
2. Observation of speech, lip sounds and oral competence.
3. Assessment of the smile and symmetry.
4. Questions about dentures, prostheses or braces, which change lip support.

Aesthetic part

1. Lines at rest and in contraction, with side light.
2. Skin quality, thickness and signs of sun damage.
3. Lip volume, definition of the vermilion and the philtrum.
4. Relationship with the maxilla and the teeth.

Standardized photos at rest, smiling and puckering, following standardized clinical photography, record the starting point. The analysis of the lip as a structure is in thin lips: assessment and aging of the perioral region.

Combined strategy

In many cases, the plan is layered, at the professional's discretion:

1. Skin care: photoprotection, hydration and dermatological options.
2. Dermal quality: biostimulation, skin boosters or microneedling, following microneedling with biostimulator or hyaluronic acid.
3. Volume and support: assessment of filler, including lip filler when it makes sense.
4. Movement: toxin, when contraction is an important factor and function allows.

The order and combination vary. What usually works is starting with what has the most impact and the lowest functional risk, reassessing with photos and only then deciding the next step.

How to talk to the patient

Avoid promising "zero lines". "Soften" and "improve" are the most honest verbs.

Where Harmy comes in

Harmy has the Lips point, which simulates volume with hyaluronic acid. It does not simulate toxin in the lip, lines or skin texture. The projection changes only the marked volume and does not retouch the skin, which avoids showing the patient a "smooth" lip that the procedure does not deliver.

Timeline of a staged plan

Quick review

Vertical lines of the upper lip illustrate a principle of HOF well: aesthetics and function live in the same structure. The toxin can help when movement is part of the problem, but it is only worthwhile when the plan considers skin, volume and, above all, what the patient does with their mouth every day.