Subcision for upper lip and cheek lines: When can it help?

Are the lines above your upper lip visible even when you are not speaking? Do some lines on your cheeks look like narrow grooves when the light catches them? Skin thinning, facial movement and volume loss can all contribute. In some lines, attachments between the skin and the tissue beneath it also help keep the depression in place.

Subcision is a minor procedure that aims to soften a suitable line by releasing these underlying attachments. The goal is a smoother transition across the upper lip or cheek area. Treatment is planned after assessing what is causing the line.

What is subcision, and what does it do beneath the skin?

Through a small entry point, a doctor uses a specialised needle or another suitable instrument to release selected connective tissue bands beneath the skin. If those bands are pulling the surface downwards, releasing them can allow the base of the line to rise. New connective tissue formed during healing may also help support the area.

The extent of treatment depends on the structure of the line. Normal facial support tissues need to be preserved, so the release is confined to the selected area.

When might it help with upper lip lines?

Vertical lines above the upper lip may first appear when you purse your lips or speak, then become visible at rest over time. During an examination, the doctor assesses their depth, skin thickness, lip movement and their relationship to the underlying tissue.

Subcision may be considered for selected, established lines where underlying attachments contribute to the depression. A line being visible at rest does not, on its own, mean that subcision is needed. If changes at the skin surface or muscle movement are the main cause, another approach may be more suitable.

For example, several fine lines that appear when you purse your lips are assessed differently from a single groove that remains when your face is relaxed. Your doctor examines the area both at rest and during movement to make this distinction.

Which cheek lines can be treated?

Fine cheek wrinkles, the nasolabial fold running from the side of the nose towards the corner of the mouth, and depressions left by acne are different concerns. Subcision targets the part of a depression or line that is tethered to the tissue below.

Any wider loss of cheek volume or sagging needs a separate assessment. If a deep fold also has underlying attachments, subcision may form part of the plan. Looking at the support of the surrounding tissue and the face as a whole helps guide the choice of treatment.

How does subcision relate to filler or Botox?

These treatments address different problems. Subcision releases an attachment beneath a line. Filler may be used in a suitable area to replace lost volume or provide tissue support. Botulinum toxin reduces movement in selected muscles.

Adding volume alone may not produce the desired surface contour when a line is held down by an attachment. In that situation, assessing the attachment first can help. If more support is still needed after release, an additional treatment may be planned. Filler is not needed with every subcision procedure.

If a treatment around the lips will affect muscle movement, functions such as speaking, drinking and smiling also need to be considered. Any combination of treatments, and the order in which they are used, is planned individually.

What happens during treatment and recovery?

The lines to be treated are identified, photographs record the starting appearance, and the area is cleaned. After local anaesthetic has numbed the area, the doctor performs the controlled release. The instrument and treatment area are chosen according to the anatomy and the type of line.

Swelling, bruising and tenderness can occur afterwards. Bruising may remain visible for several days and can last longer in some people. Allow time for recovery, particularly if you have an important meeting or social event coming up.

Your aftercare plan covers cleansing, sun protection and when to return to everyday activities. Do not apply firm massage, suction or pressure to the area yourself. Follow the care and review plan you are given.

When can you assess the result, and how many sessions are needed?

Some of the fullness in the first few days comes from swelling. The result is assessed once this has settled and the tissue has had time to heal. At follow-up, the depth of the line and its transition into the surrounding skin are compared under similar lighting and with a similar facial expression.

Changes may become clearer over the following weeks, while connective tissue continues to remodel over the coming months. The number of sessions depends on the line, the extent of treatment and the healing response. A review after the first procedure helps determine whether another session is needed.

The realistic aim is to reduce the depth of selected lines and the shadows they create. As skin ageing and facial movement continue, maintenance or further treatment may be needed over time.

What should you tell your doctor before treatment?

Tell your doctor about blood-thinning medicines, supplements, and any history of easy bruising or bleeding. Do not stop prescribed medicines on your own. Mention any previous filler, thread or other procedures in the same area.

Treatment is postponed if there is an active cold sore or skin infection. Recurrent cold sores, a history of raised or keloid scars, and conditions that could affect healing are assessed beforehand. The possibility of firmness or raised connective tissue, particularly above the upper lip, is considered when deciding how much to treat.

Other possible complications include infection, persistent firmness, changes in skin colour, scarring or altered sensation. Blood vessels or nerves can also be injured. Contact the treating doctor promptly if you develop increasing pain, spreading redness, fever or a marked change in skin colour.

What goal should you discuss at your consultation?

Point out the line that bothers you most and explain when you notice it: when your face is relaxed, when you smile, or when you wear make-up. Ask which part of the line subcision could address, how much recovery time to allow and when the result will be reviewed.

Sources

• Orentreich and Orentreich: Defining subcision. The original publication describing release beneath depressed scars and wrinkles, and connective tissue formation during healing.
• Sulamanidze and colleagues: Wire release for facial lines. A clinical series assessing a different subcision technique for facial depressions, including upper lip lines.
• Robati and colleagues: Subcision for nasolabial folds. A small study without a control group examining appearance and follow-up outcomes in folds between the nose and the corners of the mouth.
• Sasaki: Subcision alone and with additional treatments. A clinical series assessing wire subcision for established lines, folds and scars, including its use with filling materials and surgery.
• Ebrahim and colleagues: Tissue healing and instrument choice. A comparison of clinical and microscopic changes after needle and cannula subcision for acne scars. It does not establish a response rate for upper lip lines.
• Nilforoushzadeh and colleagues: Cannula and needle comparison. A clinical study examining how instrument choice may affect response and adverse effects when treating depressed acne scars.