Smokers Lines: Why They Appear Without Smoking

A name that sends people to the wrong answer

Smokers lines are the short vertical creases that run up from the border of the upper lip toward the nose. They are also called perioral lines, lip lines, or barcode lines, and the last one is the most descriptive of the four.

The name is a problem in the consulting room, because it does two things at once. It makes people who never smoked assume they have something else, and it makes people who did smoke assume the damage is a verdict rather than a treatable finding. Neither is true. Smoking accelerates the process, which is why somebody noticed the association and it stuck. It is not required to produce the result.

What is actually happening in that small patch of face is four things at the same time.

The skin there is thin to begin with, with very little fat beneath it to hold it smooth.
The muscle around the mouth is a ring, not a strap. It contracts inward toward a centre point, so every purse folds the skin along the same lines, and it does so thousands of times a day for talking, eating and drinking.
The area catches sun and is routinely missed by sunscreen, because people stop at the lip border or wipe it off when they eat.
Collagen declines with age everywhere, and thin skin shows the loss first.

Put a habit on top of any of that and the lines arrive earlier. Straws, wind instruments and years of outdoor work all do a version of the same thing. So does genetics, which is why some people in their thirties have them and some people in their sixties do not.

What they are not

Three other things around the mouth get confused with these lines, and all three have different treatments. Getting the name right in your own head is most of the way to getting the right advice.

Not marionette lines

Marionette lines run downward from the corners of the mouth toward the chin. They are mainly a descent problem, meaning tissue that has dropped and now casts a shadow, and they usually respond to restoring support and volume. Smokers lines run upward from the lip and are a skin surface problem. Same region of the face, opposite direction, different tissue, different answer.

Not nasolabial folds

The nasolabial folds are the diagonal creases from the sides of the nose to the corners of the mouth. Everybody has them, including children, because they mark where the cheek meets the lip. They deepen with age rather than appear. Our dermal fillers article covers how those are assessed and what volume can reasonably do there.

Not lost lip volume

This is the most common mix-up, and it matters because it sends people to the wrong treatment. As the lip loses volume its border softens, the pink rolls inward, and the whole area looks older. That is a volume change in the lip itself. The vertical creases in the skin above the lip are a separate change in a separate tissue. Somebody can have one without the other, and plenty of people have both and only notice one. If the lip is what has changed, lip augmentation is the conversation. If the skin above it is what has changed, filling the lip will not smooth it.

The distinction that decides your treatment

Before anything else, work out whether your lines are there at rest.

Sit in front of a mirror with your face completely relaxed. Do not smile, do not purse, do not talk. Look at the skin above your upper lip.

If the lines are visible with the face at rest, they are etched. The skin has been folded so many times that the crease is now part of its structure. These need the skin itself treated.
If the lines only appear when you purse or sip, they are movement lines. The skin is still smooth and is being folded by muscle. These respond to reducing the folding.
If both, which is common after about forty, you are treating two things and one treatment will give you a partial result.

This is a two minute test and it changes the plan more than almost anything else in the examination. It is also the reason two people with what looks like the same complaint leave with completely different recommendations.

What treats what

Etched lines: treat the skin

When the crease is in the skin, the most direct approach is to treat the skin. Laser skin resurfacing removes damaged surface layers and prompts new collagen underneath, and the perioral area is one of the places it does its most visible work. A chemical peel reaches the same goal by a different route, and the right depth depends on how established the lines are and how much downtime you can accept. Morpheus8 works deeper, tightening and remodelling rather than resurfacing the surface, and it suits skin that has lost firmness as well as smoothness.

These are not interchangeable and the choice is not a matter of preference. It depends on the depth of the lines, your skin type, how you heal, and how much recovery time you can genuinely take. That last one is a practical constraint people underreport, and it is better discussed honestly than discovered afterward.

Movement lines: reduce the folding

Very small doses of a neuromodulator can soften the pursing action that keeps re-creasing the skin. The word to hold onto is small. The muscle around the mouth does real work, and weakening it too much affects speech, drinking from a cup and the shape of a smile. This is a place where a conservative dose from someone who treats the area often is worth more than a bargain. Our Botox article explains how that assessment is made and why the dose here is nothing like the dose used on a forehead.

Where filler fits, and where it does not

A small amount of a soft product placed superficially can improve an etched line that has not responded fully to resurfacing. It is a refinement, not a foundation. Used as the main treatment for smokers lines it tends to disappoint, because volume added under a crease makes the area fuller without making the skin smoother, and the upper lip is unforgiving about excess. A little too much is immediately visible.

When the lip itself is the issue

If what has actually changed is the proportion of the upper lip, a lip lift addresses the distance between the nose and the lip. It is a different operation for a different complaint, and it does not treat the vertical lines. It appears here only because people arrive asking about one and are really describing the other.

What tends not to work

Two patterns come up often enough to be worth naming.

Treating the lip when the skin is the problem. Volume in the lip is satisfying and immediate, so it is a common first purchase. If the complaint was the vertical creases, the creases are still there afterward, and the money is spent.

Expecting one resurfacing session to finish it. Established lines in thin skin usually improve in stages. A plan that says so at the start is more honest than one that promises everything in a single visit and then quietly proposes a second.

The area rewards patience and punishes overcorrection, which is an unglamorous thing to say and the most useful thing anyone told me about treating it.

Find out which kind you have

The examination that separates etched lines from movement lines takes minutes, and it decides whether the answer is resurfacing, a small injection, or something aimed at the lip instead.

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No, and most people who have them never smoked. The name records one contributing habit rather than the cause. The vertical lines above the upper lip form where thin skin, a dense ring of muscle that purses inward thousands of times a day, sun exposure and the ordinary loss of collagen all meet in one small area. Smoking accelerates all of that, which is why the association was noticed, but drinking through straws, playing a wind instrument, strong sun exposure and simple genetics produce the same lines in people who have never held a cigarette.

They are in different places and they behave differently. Smokers lines are short vertical creases in the skin above the upper lip, running up from the lip border toward the nose. Marionette lines run downward from the corners of the mouth toward the chin and are caused mainly by descending soft tissue rather than by creasing of thin skin. The distinction matters because the treatments differ. Marionette lines usually respond to volume replacement and support, while smokers lines are a skin surface and skin quality problem first.

Filler helps some of them and is the wrong tool for others. A line that has become etched into the skin, visible even when the face is completely at rest, may soften with a very small amount of a soft product placed superficially. Lines that appear only when you purse your lips are movement lines, and adding volume to them tends to look full rather than smooth. The upper lip is also one of the least forgiving places on the face for overcorrection, because a small excess is immediately visible and reads as treated.

For lines that are etched into the skin, resurfacing is usually the most effective single approach, because it treats the skin itself rather than pushing it out from underneath. Laser resurfacing and chemical peels both work by removing damaged surface skin and prompting new collagen, and the perioral area responds well to them. Deeper or more established lines often need a combination, and small doses of a neuromodulator may be added to reduce the pursing that keeps re-folding the skin. Which combination is right depends on how deep the lines are and how much of your result comes from movement.

Neither is aimed at the lines themselves. A lip lift shortens the distance between the nose and the lip and changes the proportion of the upper lip, and lip augmentation restores volume to the pink of the lip. Both can change how the area reads overall, and a lip that has lost its border definition often looks better after volume is restored. But the vertical creases in the skin above the lip are a separate problem in a separate tissue, and if they are what bothers you, they need to be treated directly rather than hoped away as a side effect.

Related reading: laser skin resurfacing and chemical peels for etched lines, Botox for the movement component, lip augmentation for volume in the lip itself, and lip lift for upper lip proportion.