In my opinion it really depends on the number of lines that are above the lip as to whether I would recommend fillers or dermabrasion for treatment. If there are only a few relatively deep lines across the upper lip, I think fillers are an excellent way to rid the patient of these unsightly lines. I highly recommend the hyaluronic acid fillers and would recommend that the patient stay away from virtually any other filler in this area. The only downside is that the result is only temporary and will last somewhere in the six to twelve month range. Dermabrasion on the other hand can provide a more permanent solution to the problem, but I certainly would not recommend actual dermabrasion, but would highly recommend laser skin resurfacing as this is a safer and more consistent way to obtain the result without the risks of pigmentary issues or scarring. If we are just treating the area around the mouth, these laser treatments can be performed in the spa setting using local anesthetic and are exceptionally successful at ridding the patient of these lines above the lip. This really would be the only recommendation that I would have for patients who have multiple lines above the lip and this certainly is a common problem that I see in my practice where patients will present with 10 to 20 or even more relatively deep lines across the upper lip. This really would not be an indication for fillers in this circumstance and an aggressive erbium laser resurfacing would provide absolutely outstanding results with only approximately six days of any sort of downtime.
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Deep acne scars are one of the most challenging problems that I personally face as a facial plastic surgeon. There really is no modality that can completely rid a patient of these unsightly scars. Dermabrasion certainly is an option for treatment of acne scars and has been an option for decades. The downside of dermabrasion is that it is very dependent on the experience of the surgeon performing the procedure. It is also a rather messy procedure and it can take ten days or even longer to completely heal. There is a remote risk of scarring if the procedure is performed too deeply. More recent advances for the treatment of acne scarring include erbium laser resurfacing, which allows the surgeon to have much more control over the depth of the injury. Healing time is somewhere in the one week to ten day range and the result can be rather significant. Even newer technology is the ProFractional laser resurfacing, which vaporizes small tunnels into the tissue. This can be set to go quite deep and additional heat can be set into the programming so that the deeper dermis is injured even further. During the healing process a large amount of collage in laid down into the deeper dermal layer and this in turn creates tightening and a significant reduction in the appearance of acne scarring. The advantage of this technique is that due to the fact that only a small percentage of the actual epidermis is injured, healing occurs much more rapidly. There is also a virtual elimination of any risk of scarring or pigmentary problems. The only downside to this technique is that it typically takes three treatments to obtain adequate improvement in the acne scarring. I have personally found that the ProFractional laser resurfacing can provide as good of an improvement in acne scarring or even a better appearance to the acne scarring when compared to the former modalities previously mentioned. I therefore consider