How to make aging lips look younger: 5 treatments I trust

Most people who come to me about their lips start by asking for filler. Volume is often part of the answer, but when I look closely I usually see two or three other changes too: a longer upper lip, fine lines that catch lipstick, and corners that have started to turn down. Each of those has its own fix, which is why the best results usually come from a plan rather than a single syringe.

What happens to your lips as you age?

An MRI study of 200 adults in Plastic and Reconstructive Surgery compared people in their 20s with people aged 65 to 80. In the older group, women's upper lips were about 19 percent longer, up to about 41 percent thinner, and had about 21 percent less volume. The researchers concluded that lip aging is a combination of lengthening, thinning and volume loss.

Add years of talking, smiling and sipping, and the skin above the lip folds into vertical lines. At the same time, a small muscle at each corner of the mouth keeps pulling the corners down, which can make a relaxed face look tired or unhappy.

1. Lip filler to restore volume and shape

Hyaluronic acid filler replaces the volume lips lose with age. For a mature lip I use small amounts to rebuild the border, support the shape and add a little fullness. The goal is a rested version of your own lips, not bigger ones.

You see the change right away, swelling settles over the next week or two, and lip filler typically lasts six months or longer. Hyaluronic acid filler can also be dissolved with an enzyme called hyaluronidase if it ever needs adjusting.

Best for: thinner lips, a softened border, lost shape.

2. Botox lip flip for a fuller-looking upper lip

The orbicularis oris is the ring of muscle around your mouth, and it is constantly pulling the upper lip inward. A few units of Botox placed along the upper border relax it, so the lip rolls slightly outward and more of it shows. Nothing is added, which keeps the change subtle.

Most people notice it within a few days, with the full effect at about two weeks. Because the dose is so small, a lip flip usually lasts about two to three months. For the first few days, sipping through a straw or whistling can feel a little different.

Best for: an upper lip that disappears when you smile, or anyone who wants a softer change than filler.

3. CO2 laser for lip lines and crepey skin

Injectables don't change the quality of the skin itself. Fractional CO2 resurfacing treats the vertical lines above the lip, crepey texture and etched-in wrinkles by creating tiny treatment zones that prompt new collagen.

Expect real downtime: fractional CO2 typically means several days of redness and peeling before you're back in makeup. If you've ever had a cold sore, tell your provider, because an antiviral is usually prescribed before treating around the mouth.

Best for: lipstick lines, lines around the mouth, crepey texture.

4. DAO Botox for a downturned mouth

The depressor anguli oris (DAO) runs from the jaw to each corner of the mouth and pulls the corners down. Relaxing it with a small dose of Botox lets the corners sit higher, so the mouth looks less downturned at rest.

Placement matters here. Neighboring muscles help shape your smile, so DAO Botox is a precise, low-dose treatment.

Best for: corners that turn down at rest, early shadows below the corners of the mouth.

5. Microneedling for texture and fine lines

Microneedling creates controlled micro-injuries that signal the skin to build collagen. Around the lips it softens fine lines and improves texture, usually with a day or two of pinkness.

It works gradually, so plan on a series, typically three to four sessions spaced four to six weeks apart, with maintenance sessions after that.

Best for: early fine lines, overall skin quality, anyone not ready for laser downtime.

Which lip treatment is right for you?

• Lips look thinner or have lost their shape: lip filler
• Your upper lip disappears when you smile: Botox lip flip
• Lines or crepey skin around the mouth: CO2 laser or microneedling
• Corners of the mouth turn down: DAO Botox

Most mature lips show more than one of these changes, so combination treatments are common. A lip flip with a small amount of filler, or filler followed by a resurfacing series, are the plans I build most often.

One note on labels: Botox Cosmetic is FDA-approved for frown lines, crow's feet, forehead lines and neck bands. A lip flip and DAO Botox are common off-label uses, which is one more reason to choose an experienced injector.

FAQ

Sources

1. Aging of the Upper Lip: Part I, a retrospective analysis of metric changes in soft tissue on MRI, Plastic and Reconstructive Surgery
2. What causes aging of the upper lip? Loss of volume, not just sagging, American Society of Plastic Surgeons
3. Lip augmentation with hyaluronic acid fillers: a review of considerations and techniques, Journal of Drugs in Dermatology
4. Lip Flip: What You Need to Know, Anne Arundel Dermatology
5. Elevation of the corner of the mouth using botulinum toxin type A, Journal of Cutaneous and Aesthetic Surgery
6. Fractional technology brings new life to CO2 laser, MDedge Dermatology
7. How many microneedling sessions do you need?, U.S. Dermatology Partners
8. BOTOX Cosmetic (onabotulinumtoxinA) Prescribing Information, AbbVie