How to treat those deep smile lines

I’m glad to see a new attitude about being healthy, feeling healthy and looking healthy…

We’ve learned a lot over the last few decades about foods, nutrients, exercise, and how these basics play an important role in helping us live a long and disease-free life.

So it only makes sense that more and more people are opening up to safe, non-surgical ways to project from their face, the youthful vitality they feel inside.

It’s not for everyone, but if you’ve ever been curious about nonsurgical procedures to feel more comfortable in your skin, I hope I can help answer your questions…

In my previous article I discussed how botox works for rapid reversal of facial wrinkles. Today, let’s look at my other two favorite nonsurgical cosmetic procedures: dermal fillers and platelet-rich plasma (PRP).

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Dermal Fillers

This treatment opens a whole new aspect of nonsurgical face lifts, with immediate results and no down-time. And a lot of people of taking advantage of it: there were 2.6 million dermal filler procedures reported in 2016.

Areas most frequently treated are deep creases in the nasolabial folds (“smile lines” or “laugh lines”), oral commissures (“marionette lines”), glabella (deep scowl lines between the eyebrows), tear troughs and to lift the cheeks. You probably also know it is used to plump the lips or define the lip borders.

The procedure takes about 20-30 minutes. A topical numbing cream is applied 15 minutes prior to injecting dermal filler which makes an otherwise mild burning sensation barely detectable. Results last from 6 to 12 months or longer.

You might wonder what is in dermal fillers and if it is safe…

There are a few different types of fillers, but I prefer hyaluronic acid (HA). HA is the main structural component found in skin, much like collagen. It is a polysaccharide (long sugar chain) that makes the dermis layer of your skin smooth and healthy. Its other main effects are to lubricate joints (synovial fluid) and heal connective tissues.

The HA in dermal filler is formed naturally by streptococcus bacteria. It is not immunogenic (cannot cause an immune reaction) and naturally biodegradable. Furthermore, hyaluronic acid is hydrophilic (“water-loving”), which means it can hydrate the skin too.

To make HA in commercial dermal filler last longer, it is chemically “cross-linked” with a viscous, moisture-absorbing gel such as BDDE (1,4-butanediol diglycidyl ether). When these two naturally degrade, they become harmless byproducts that are identical to substances already found in the skin.

If a dermal filler injection results in an uneven or bumpy area, or if it is overfilled, it can be reversed (dissolved) by injecting the enzyme hyaluronidase (a.k.a. Rituximab) — without dissolving the natural hyaluronic acid of your surrounding normal tissue.

The cost of dermal fillers typically ranges from $600 to $1,500 per syringe, and depending on treatment may require multiple injections.

Platelet Rich Plasma (PRP) Injections

The next procedure, though it involves injections, is different from a dermal filler procedure.

The use of “autologous” (meaning “your own”) platelet-rich plasma (taken from your blood) for tissue repair started in the 1990’s.

By 2006, it was being used across many fields of medicine for healing and even began to be covered by insurances. That’s because it is known to be rich in fibrin and many different important growth factors that stimulate stem cells to grow and tissues to regenerate rapidly.

Now it is used to regenerate skin, joints and hair. It is now even used with impressive results to reverse sexual dysfunction in men and women.

Therefore, PRP is being injected for cosmetic purposes. Studies and clinical experience are confirming its effectiveness for acne and other scar revision, skin rejuvenation, dermal augmentation and stretch marks.

The cost of PRP is somewhat similar to dermal filler treatment, ranging from $600 to $1800 depending on the area being treated and number of injections. The effects can last from 12 months to 2 years depending on your age and initial skin health.

A big plus about using PRP is that because it comes from your own blood, there is no risk for allergic reaction or rejection…

Also, platelets and growth factors from your own blood stimulate a stem cell response, which promotes new connective tissue (skin) cells. They also stimulate collagen and blood vessels, cause repair of damaged skin, and to help slow skin aging.

Ten ml (1 vial) of your blood is drawn and spun down by a centrifuge for approximately six minutes to retrieve the platelet rich and fibrin rich portion of the blood plasma. This is then reinjected into the tissue being treated.

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The indications for the skin cosmetic use of PRP include:

  • Skin rejuvenation: for reducing fine lines and wrinkles such as crow’s feet and tear troughs (dark circles under eyelids)
  • Tightening skin and dermal augmentation for mild collagen and volume loss
  • Scar revision, including acne scars and rosacea
  • Stretch marks (striae distensae)
  • Lip and frown lines
  • Deep depressions around the nose and mouth
  • Volume loss in the cheeks
  • Sagging around the jaw line
  • Dehydrated skin

Within a few weeks after just one treatment you can expect to see improvement in skin hydration, texture and tone. Although it is a gradual improvement over 3 to 5 weeks, there will be new collagen and blood vessels growing. After 3 to 6 months there will be full effect of its correction of fine lines, wrinkles, and volume depletion. You can expect to see a longer-lasting effect than dermal fillers. It is used for larger areas of skin rather than small isolated defects seen with dermal fillers. PRP can be combined with dermal fillers and botulinum toxin for optimal overall cosmetic results.

Effects of PRP can last as long as 18 months. And as always you should only receive a cosmetic procedure from a licensed and qualified practitioner.

I am excited to share in my next article about the impressive results doctors are getting with PRP for joint healing, hair restoration, and sexual dysfunction reversal.

To your long-term health and to feeling good,

Michael Cutler, M.D.


  1. 2016 Plastic Surgery Statistics Report — ASPS National Clearinghouse of Plastic Surgery Procedural Statistics
  2. De Boulle K, Glogau R, Kono T, Nathan M, Tezel A, Roca-Martinez JX, Paliwal S, Stroumpoulis D. A review of the metabolism of 1,4-butanediol diglycidyl ether-crosslinked hyaluronic acid dermal fillers.Dermatol Surg. 2013 Dec;39(12):1758-66.
  3. Kim JE, Sykes JM. Hyaluronic acid fillers: history and overview.Facial Plast Surg. 2011 Dec; 27(6):523-8.
  4. Leo MS, Kumar AS, Kirit R, Konathan R, Sivamani RK. Systematic review of the use of platelet-rich plasma in aesthetic dermatology.J Cosmet Dermatol. 2015 Dec;14(4):315-23. PubMed PMID: 26205133.
  5. Redaelli A, Romano D, Marcianó A. Face and neck revitalization with platelet-rich plasma (PRP): clinical outcome in a series of 23 consecutively treated patients. — J Drugs Dermatol. 2010;9:466–472. [PubMed]
  6. Kim DH, Je YJ, Kim CD, et al. Can Platelet-rich Plasma Be Used for Skin Rejuvenation? Evaluation of Effects of Platelet-rich Plasma on Human Dermal Fibroblast. — Annals of Dermatology. 2011;23(4):424-431.
Dr. Michael Cutler

By Dr. Michael Cutler

Dr. Michael Cutler is a graduate of Tulane University School of Medicine and is a board-certified family physician with more than 20 years of experience. He serves as a medical liaison to alternative and traditional practicing physicians. His practice focuses on an integrative solution to health problems. Dr. Cutler is a sought-after speaker and lecturer on experiencing optimum health through natural medicines and founder of the original Easy Health Options™ newsletter — an advisory on natural healing therapies and nutrients. His current practice is San Diego Integrative Medicine, near San Diego, California.