Perioral lines, commonly known as smoker lines or lipstick lines, are vertical wrinkles arranged radially around the lips — radiating outward from the vermilion border, primarily distributed around the upper and lower lips, with the upper lip being more prominent. Perioral lines are among the earliest aging wrinkles on the face — typically appearing in the late 30s and gradually deepening in the 40s-50s. The causes are multifactorial: (1) Repetitive orbicularis oris contraction — speaking, eating, smoking, and using straws cause frequent contraction, eventually creating vertical creases on the skin. (2) Collagen loss — as we age, collagen and elastin fibers decrease in perioral skin, making it thinner and less elastic, so creases formed by muscle contraction cannot bounce back. (3) Photoaging — UV damage accelerates collagen degradation in perioral skin. (4) Habitual lip pursing — unconscious lip pursing or biting when stressed worsens perioral lines. (5) Bone resorption — maxillary and mandibular bone resorption with age reduces skeletal support around the mouth, causing skin laxity and wrinkling. Rappoel Dermatology near Gangnam Station, Seoul, uses Korea’s Coretox botulinum toxin — micro-injections into the orbicularis oris for safe and effective perioral line improvement, restoring smooth, youthful perioral skin.
Technical Principles of Coretox Perioral Lines Treatment
- Botox weakens orbicularis oris contraction: Coretox is botulinum toxin type A — when injected into the orbicularis oris, it blocks acetylcholine release at the neuromuscular junction, reducing the muscle’s contraction force. With weakened contraction, vertical skin creases become shallower and shorter — clinical data shows 40-60% average improvement in perioral line depth at 1-2 weeks post-injection
- Coretox Korean-origin high-purity advantage: Coretox is a 150kDa high-purity toxin — unnecessary complex proteins removed, theoretically reducing antibody formation and resistance risk. Perioral line treatment requires long-term repeated injections (typically every 3-4 months), making high-purity formulation more beneficial for consistent long-term results
- Faster onset (2-3 days): Coretox clinical data shows average onset of 2-3 days — perioral lines begin to soften at 3-5 days, optimal results at 1-2 weeks
- Precise diffusion control: The perioral area is adjacent to the lips — excessive toxin spread to lip muscles may cause asymmetry, unnatural smiling, or eating difficulty. Coretox’s smaller diffusion range makes it safer for perioral injection
- Preservative-free hypoallergenic formulation: Coretox contains no animal-derived proteins or human serum albumin — reducing allergic reaction risk
Precise Technique and Safety for Perioral Injection
- Micro-dose injection principle: The orbicularis oris is essential for lip closure and articulation — dosage must be extremely precise. Over-injection causes lip weakness, slurred speech, and eating difficulty (especially with straws). Rappoel uses 1-2 units per point, with total upper lip dosage not exceeding 4-6 units
- Symmetric injection for natural results: Upper lip perioral lines are typically symmetrically distributed — Rappoel physicians inject 2-3 points on each side in symmetric positions, ensuring consistent left-right results. Asymmetric injection may cause crooked smiling
- Depth control: Injection into the superficial layer of the orbicularis oris — too deep may affect deep muscle function. 32G ultra-fine needle used in the subdermal/superficial muscle layer
- Avoiding the vermilion border: Injection points are 3-5mm lateral to the vermilion border — not directly at the border to avoid affecting lip shape
- Lower lip management: Lower lip lines are typically milder than upper — if needed, dosage is halved (total 2-3 units)
Rappoel Perioral Botox Injection Treatment Protocol
- Facial assessment and plan design (10 min): Evaluate perioral line depth and distribution → patient performs pursing and smiling to observe crease changes → assess lip function (articulation, closure) → establish injection plan (points, dosage, symmetric distribution)
- Disinfection preparation (5 min): Facial cleansing → povidone-iodine perioral preparation → mark symmetric injection points
- Precise micro-injection (8-10 min): 32G ultra-fine needle → 2-3 injection points per upper lip side (3-5mm from vermilion border) → 1-2 units Coretox per point → lower lip 1-2 points per side if needed → gentle pressure after injection
- Immediate assessment and guidance (5 min): Patient performs smiling, pursing, and articulation to confirm normal function → post-care instructions (avoid pressing perioral area, avoid lying flat for 4 hours, avoid strenuous exercise for 24 hours) → 2-week follow-up scheduled for effect evaluation
The entire perioral Coretox injection takes about 20 minutes, with onset at 3-5 days, optimal results at 1-2 weeks, lasting 3-4 months. Located 3 minutes from Gangnam Station Exit 10, with seamless English and Chinese consultation.
Frequently Asked Questions
Will perioral Botox affect speaking and eating?
At correct dosage, normal function is unaffected. Rappoel uses micro-doses (total upper lip 4-6 units), only weakening the superficial layer’s excessive contraction without affecting deep muscle function. Mild lip weakness may be felt for 2-7 days post-injection — particularly when using straws or whistling, but daily speaking and eating are completely unaffected. Precautions: (1) Avoid very hard foods for 1 week. (2) Avoid habitual lip pursing or biting. If significant lip weakness or asymmetry occurs (usually from excessive dosage), the dose is reduced at the next session. The vast majority of patients experience significant perioral line improvement with completely normal lip function.
How long does perioral Botox last? How often should I get it?
Perioral Botox typically lasts 3-4 months — because the orbicularis oris is a high-frequency muscle (contracting during speaking and eating), neuromuscular junction regeneration is slightly faster than other areas. Rappoel recommends: injection every 3-4 months for maintenance. With regular treatment, some patients find they can extend to 4-5 month intervals — because reducing excessive contraction allows skin creases to gradually soften, improving baseline condition. Regarding resistance: long-term repeated injections may produce neutralizing antibodies — incidence approximately 1-5%. Coretox’s high-purity formulation theoretically reduces antibody risk. Minimum 3-month intervals recommended with lowest effective dose.
Which is better for perioral lines: Botox or HA filler?
They work through different mechanisms and can complement each other: (1) Botox — reduces dynamic lines (wrinkles appearing during expression) by weakening muscle contraction, ideal for muscle-induced perioral lines. Pros: excellent for dynamic lines, lasts 3-4 months. Cons: limited effect on static lines (deep wrinkles present without expression). (2) HA filler — physically fills depressed creases, ideal for static deep lines. Pros: instant filling, lasts 6-12 months. Cons: doesn’t address muscle contraction, dynamic lines persist. (3) Combined — Botox + HA is the optimal approach: Botox reduces contraction (preventing new lines), HA fills existing deep lines (instant improvement). Inject Botox first, assess after 2 weeks, then decide if HA supplementation is needed. Rappoel recommends based on perioral line type.
What is the difference between Coretox and Botox for perioral lines?
Coretox and Botox are both botulinum toxin type A, with these main differences: (1) Purity — Coretox is 150kDa high-purity toxin with complex proteins removed; Botox is 900kDa complex. (2) Onset speed — Coretox averages 2-3 days; Botox typically 5-7 days. Perioral line patients usually want fast results, making Coretox advantageous. (3) Diffusion range — Coretox has smaller diffusion, safer for perioral injection (reduced risk of spreading to lip muscles causing weakness). (4) Formulation — Coretox contains no animal-derived proteins or albumin, lower allergy risk. Both last similarly (3-4 months). Rappoel selects based on patient needs — Coretox recommended for those wanting fast results or experiencing diminished Botox effect.
Can perioral lines be completely eliminated? How to prevent worsening?
Improvement depends on wrinkle depth: (1) Fine lines (mainly dynamic) — Botox can improve 70-90%, approaching complete elimination. (2) Moderate lines (dynamic + mild static) — Botox improves 50-70%, may need combined HA filler for static lines. (3) Deep lines (prominent static) — Botox improves 30-50%, requires combined HA or fractional laser. Prevention methods: (1) Sun protection — UV accelerates perioral collagen degradation, apply sunscreen daily. (2) Quit smoking — repetitive pursing during smoking accelerates line formation. (3) Reduce straw use — straws cause excessive orbicularis oris contraction. (4) Moisturize — perioral skin is thin and prone to dryness, use lip balm and moisturizer. (5) Avoid habitual pursing and lip biting. Comprehensive management and regular treatment can keep perioral lines at their mildest.
Perioral lines making you look older? Rappoel Coretox perioral treatment — visible results in 3 days!
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