8-minute read
Vertical lines above the upper lip are common as skin ages.
They are also unusually difficult to treat because the mouth is not a decorative feature. It speaks, smiles, eats, drinks and expresses emotion throughout the day.
That makes the sensible question more complex than “How do I erase these lines?” A better question is: “Which options can soften them, what can each option realistically achieve, and what might I risk in the process?”
Why Vertical Upper Lip Lines Develop
These lines are often called perioral rhytides. “Smoker’s lines” is also widely used, but it is a misleading label. Many people who have never smoked develop them.
Their development usually reflects several overlapping changes:
· repeated movement of the orbicularis oris muscle around the mouth;
· gradual loss and reorganisation of collagen and elastin;
· cumulative ultraviolet exposure;
· changes in skin thickness, hydration and barrier lipids;
· changes in facial fat, teeth, bone and soft-tissue support;
· genetics, hormonal changes and smoking exposure.
Normal facial expression is not a bad habit. Advice to stop smiling, kissing, talking or occasionally using a straw is neither practical nor supported as a meaningful anti-ageing strategy. Smoking is different because it combines repeated pursing with oxidative and vascular effects that accelerate skin ageing.
What Skincare Can Realistically Do
Skincare cannot replace lost facial support or erase a deeply established crease. It can, however, improve hydration, reduce roughness, support the skin barrier and gradually soften the appearance of some fine lines. It can also help prevent additional photodamage.
1 - Daily Sun Protection
Broad-spectrum sun protection is the least glamorous and most defensible starting point. Ultraviolet exposure contributes to collagen breakdown and other features of photoageing. Sunscreen does not iron out an existing line, but it helps reduce further avoidable damage.
2 - Hydration and Barrier Support
Humectants, emollients and barrier-supporting lipids can make dry, finely lined skin look smoother. The effect is valuable but mainly cosmetic and temporary. Think of it as improving the condition of the fabric, not rebuilding the frame beneath it.
3 - Retinoids
Topical tretinoin has the strongest evidence among topical treatments for facial photoageing. Retinol also has supporting evidence, although products vary greatly in concentration, stability and delivery. Retinoids can cause dryness, scaling, burning or irritation, particularly around the mouth. That does not make them inherently destructive, but it does mean that tolerance and appropriate use matter.
Evidence for facial photoageing should not be quietly converted into a promise that a retinoid will remove vertical upper lip lines. Location-specific results are less certain, especially for deeper structural creases.
4 - Bakuchiol
Bakuchiol is chemically different from retinol. A small randomized, double-blind 12-week study compared 0.5% bakuchiol used twice daily with 0.5% retinol used once daily in 44 participants with facial photoageing. Both groups improved in the measured wrinkle and pigmentation outcomes, while retinol users reported more scaling and stinging.
That is encouraging evidence for bakuchiol as a generally well-tolerated option. It does not prove that bakuchiol and retinol are interchangeable in every formulation, or that either specifically corrects established upper lip lines.
5 - Peptides & Antioxidants
Palmitoylated peptides are designed to participate in cell-signalling pathways associated with extracellular-matrix maintenance. Laboratory studies and some finished-product trials are encouraging, but the evidence varies by peptide, concentration, delivery system and final formulation. Much of the most specific commercial data comes from ingredient suppliers rather than large independent trials.
Vitamin C is required as a cofactor for enzymes involved in collagen biosynthesis and also contributes antioxidant activity. Yet the presence of vitamin C or peptides in a formula does not prove that it will rebuild deep lines. Their most defensible role is as part of a well-designed routine supporting the appearance and condition of ageing skin over time.
Do Facial Exercises Help
Facial exercises are appealing because they are inexpensive and non-invasive.
The evidence is far less satisfying. Systematic reviews have found small studies, varied methods and inconsistent outcome measures. Some regional improvements have been reported, but current evidence is insufficient to conclude that facial exercises reliably rejuvenate the face.
There is no robust clinical evidence that repeatedly puckering, stretching or manipulating the upper lip erases vertical lines. It is also too simplistic to claim that every facial exercise necessarily worsens them. For now, targeted upper-lip routines belong in the “unproven” category—not the “clinically validated” one.
What About Cosmetic Acupuncture
Cosmetic acupuncture has a growing research literature, including some recent controlled studies. However, studies vary in technique, comparators and measured outcomes. Evidence specific to established vertical upper lip lines remains sparse.
Someone may still choose acupuncture for relaxation or personal wellbeing. That is different from claiming that it reliably remodels perioral wrinkles. Enjoyment and evidence are both legitimate considerations, provided they are not confused with one another.
As the image below shows there can be some softening of these lines, but notice that the image on the right is one of lips with make-up, which will naturally look more appealing.
Which Clinical Treatments Have Better Evidence
1 - Laser Resurfacing
Fractional ablative and non-ablative lasers create controlled zones of injury that stimulate repair and remodelling. Studies and clinical reviews support improvements in facial and perioral wrinkles. Ablative treatments can produce more marked change but generally involve greater downtime and risk. Pigmentary alteration, prolonged redness, infection and scarring are among the matters a clinician should discuss.
2 - Microneedling & Radiofrequency Microneedling
Microneedling creates controlled micro-injuries. Radiofrequency microneedling also delivers energy below the surface. Recent systematic reviews report improvements in texture, tightening and wrinkle measures, with mostly temporary redness and swelling in published studies. However, devices, treatment settings and study methods differ, so results cannot be guaranteed or transferred automatically from one machine to another.
3 - Botulinum Toxin
Botulinum toxin is not automatically forbidden around the mouth. Experienced medical practitioners sometimes use very small, carefully placed doses to reduce excessive muscular pull. The margin for error is narrower than in some other facial areas. Too much effect can alter lip movement, speech, drinking, smiling or symmetry.
A “lip flip” and treatment of vertical perioral lines are also not identical objectives. Anyone considering treatment should ask precisely what is being treated, what product and dose are proposed, and how function could be affected.
4 - Fillers & Injectable Bioremodelling
The statement that fillers should never be used in the perioral area is too absolute. Different products and injection strategies may be used to address volume loss, lip support or selected lines. They do not all behave like thick volumising filler placed directly beneath every crease.
Nor does that make fillers trivial. The area is mobile, anatomically complex and highly visible. Possible problems include lumps, asymmetry, migration, over-projection and, rarely, vascular complications. The important question is not simply “filler or no filler?” It is whether the proposed treatment suits the anatomy, the concern and the person’s tolerance for risk.
Manage Your Expectations
Images showing a perfectly smooth upper lip can be visually appealing, but they are not always realistic treatment benchmarks.
Some are digitally retouched or AI-generated, as the image above is. They represent a static, reconstructed appearance—not living tissue that must stretch, fold and move whenever we speak, smile, eat or drink.
Treatments can soften vertical upper-lip lines, improve skin texture or reduce their visibility. The degree of improvement will depend on the depth and cause of the lines, skin quality, age, facial anatomy, muscle movement, treatment selected and individual response. Complete removal is unlikely, particularly where lines are already established.
A realistic goal is therefore visible improvement while preserving natural movement and function—not an unnaturally smooth, motionless upper lip. Before choosing a procedure, ask to see unretouched photographs of comparable patients, taken under consistent lighting and facial positioning. AI-generated perfection may be aspirational, but it should never be presented as a probable clinical outcome.
Where Azurlis™ Fits
Azurlis™ does not promise that a cosmetic formula can erase structural upper lip lines.
The Luminous Bakuchiol Serum is formulated with 0.9% bakuchiol, niacinamide, N-acetyl glucosamine, THD ascorbate and Palmitoyl Tripeptide-1, Palmitoyl Tetrapeptide-7 and Palmitoyl Tripeptide-38. Together, these ingredients are designed to support hydration, tone, texture and the appearance of ageing skin with consistent use.
The Face & Body Elixir combines emollient botanical oils, rice phytoceramides, THD ascorbate and Palmitoyl Tripeptide-1 and Palmitoyl Tetrapeptide-7. Its more immediate contribution is comfort, softness and reduced dryness—not injectable-style volume or a structural facelift in a bottle.
Both can form part of thoughtful long-term care. Neither should be presented as a substitute for a medical procedure when the concern is a deep, established crease.
The No Nonsense Conclusion
Upper lip lines are normal, multifactorial and difficult to treat.
Skincare can improve hydration, texture and the appearance of finer lines while helping to limit further photodamage. It cannot restore lost bone or dental support, stop normal mouth movement or erase every structural crease.
Procedures may create more visible change, but stronger intervention brings greater cost, downtime and risk. Around the mouth, the best aesthetic outcome is not simply smoother skin. It is smoother-looking skin attached to a mouth that still performs its full job description.
If you are considering injectables, laser resurfacing or radiofrequency microneedling, seek an appropriately qualified medical practitioner experienced in perioral treatment. Ask what improvement is realistic, how long it may last, what complications are possible and what happens if the result is not what you expected.
Evidence Notes & References
Directly Relevant to Why Upper-lip Lines Develop
Bravo, B.S.F., et al. 2022. “Perioral Rejuvenation in Aesthetics: Review and Debate.” Clinics in Dermatology, 40: 123–131.
Why it is included: This was the principal overview for lasers, fillers, neurotoxins, microneedling and RF around the mouth. pubmed.ncbi.nlm.nih.gov
Tierney, E.P., et al. 2013. “Fractional Carbon Dioxide Laser Resurfacing of Rhytides and Photoageing: A Prospective Study Using Profilometric Analysis.” Clinical and Experimental Dermatology.
Why it is included: Useful for measured wrinkle outcomes across several facial areas, including the perioral region.
Botulinum Toxin & Dermal Fillers
Lorenz, F.J., Schopper, H.K., and Walen, S.G. 2025. “The Role of Toxins and Fillers in Optimizing Perioral Rejuvenation.” Facial Plastic Surgery, 41.
Why it is included: Supports the nuanced position that injectables are neither universally forbidden nor universally appropriate around the mouth. Penn State
Manstein, D., et al. 2008. “Low Density, Non-Ablative Fractional Laser Rejuvenation.” Lasers in Surgery and Medicine.
Why it is included: Included reported improvement in visible perioral wrinkles.
Converset, S., et al. 2025. “Lip Enhancement and Perioral Area Correction With New Hyaluronic Acid Dermal Fillers: A Prospective Safety Study.” Aesthetic Surgery Journal Open Forum, 7: ojaf101. DOI: 10.1093/asjof/ojaf101.
Why it is included: This is extremely relevant: 72 participants, with 61 also treated for lip fine lines and nasolabial folds. Lip function was reportedly unaffected, and improvement in fine lines persisted in many participants at 12 months. However, it was uncontrolled, product-specific, manufacturer-sponsored and classified as Level IV evidence. It supports “fillers can be used successfully in selected cases,” not “fillers are conclusively safe around every mouth.” PubMed
Topical Skincare & Photoageing – What Skincare Can Do
Dhaliwal, S., et al. 2019. “Prospective, Randomized, Double-Blind Assessment of Topical Bakuchiol and Retinol for Facial Photoageing.” British Journal of Dermatology, 180: 289–296.
Why it is included: This is the 44-participant bakuchiol-versus-retinol study. It concerns whole-face photoageing - not upper-lip lines specifically. pubmed.ncbi.nlm.nih.gov
Sitohang, I.B.S., et al. 2022. “Topical Tretinoin for Treating Photoaging: A Systematic Review of Randomized Controlled Trials.” International Journal of Women’s Dermatology, 8: e003.
Why it is included: Supports tretinoin’s evidence for facial photoageing while preserving the distinction from perioral-specific evidence. pubmed.ncbi.nlm.nih.gov
Berry, K., Hallock, K., and Lam, C. 2022. “Photoaging and Topical Rejuvenation.” Facial Plastic Surgery Clinics of North America, 30.
Why it is included: Used for photoprotection, retinoids, niacinamide, vitamin C and the general limits of topical treatment. Penn State
Robinson, L.R., et al. 2005. “Topical Palmitoyl Pentapeptide Provides Improvement in Photoaged Human Facial Skin.” International Journal of Cosmetic Science, 27: 155–160.
Why it is included: Included only as broader peptide evidence. It does not study the same peptide combination used by Azurlis™, which is explicitly stated in the reference notes.
Microneedling & Radiofrequency
Foppiani, J.A., Fanning, J.E., and Beltran, K. 2025. “Microneedling for Facial Rejuvenation: A Systematic Review.” Aesthetic Plastic Surgery, 49: 4949–4960.
Why it is included: Supports potential benefits while identifying inconsistent treatment protocols and outcome measures. Springer Nature Link
Kumar, N., et al. 2026. “Radiofrequency Microneedling for Facial Rejuvenation: A Systematic Review.” Journal of Cosmetic Dermatology, 25: e70845.
Why it is included: This is open access through PubMed Central. It reviewed 20 studies involving 558 participants, although several authors had industry relationships that should be noted. PubMed
Facial Exercise & Massage
Van Borsel, J., et al. 2014. “The Effectiveness of Facial Exercises for Facial Rejuvenation: A Systematic Review.” Aesthetic Surgery Journal, 34: 22–27.
Why it is included: Concluded that more consistent randomized evidence is required.
Shaikh, S.S., et al. 2025. Efficacy of Conservative Techniques for Mechanical Facial Rejuvenation: A Systematic Review. Aesthetic Surgery Journal Open Forum, 7: ojaf144.
Why it is included: Particularly useful because it covers facial exercises, myofunctional approaches and massage. It found some regional improvements but insufficient evidence for confident rejuvenation claims. It is freely available through PubMed Central. PMC
Cosmetic Acupuncture
Haghir, H. et al. 2025. Is Acupuncture Effective in Diminishing Frown Lines? Evidence From a Randomized Controlled Trial. Journal of Cosmetic Dermatology, 24: e70144.
Why it is included: This randomized waitlist-controlled trial provides preliminary evidence that a six-week course of combined facial and body acupuncture may reduce glabellar frown-line severity in women aged 30–59. It is relevant because controlled research on cosmetic acupuncture remains limited. However, the study did not investigate vertical upper-lip lines, and the anatomical and mechanical differences between the glabellar and perioral regions mean its findings cannot be directly extrapolated to them. The small, single-centre, women-only sample, waitlist control and short follow-up also limit generalisation. It therefore supports describing cosmetic acupuncture as an emerging area of research—not as an established treatment for vertical upper-lip lines. pubmed.ncbi.nlm.nih.gov
Choosing Between Cosmetic & Surgical Approaches
Corduff, N. 2023. “Surgical or Nonsurgical Facial Rejuvenation: The Patients’ Choice.” Plastic and Reconstructive Surgery Global Open, 11(10): e5318. DOI: 10.1097/GOX.0000000000005318.
Why it is included: This is not an upper-lip treatment study. It is an informal survey of 72 women and is valuable for realistic expectations, patient priorities and the danger of expecting nonsurgical procedures to deliver surgical outcomes.
Chennupati, V., et al. 2026. “Nonsurgical Facial Rejuvenation: Principles and Techniques in Aesthetic Plastic Surgery.” Annals of Plastic Surgery, 97(3S): S188–S195. DOI: 10.1097/SAP.0000000000004793.
Why it is included: Excellent current umbrella review for phototype, barrier status, photoprotection, topical care, peels, microneedling and lasers. It is not specifically about upper-lip lines. pubmed.ncbi.nlm.nih.gov
