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have you been noticing those smile lines
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creeping in if they're starting to bug
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you stick around because I'm diving into
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the best ways to improve
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them I'm Dr Sam Ellis and I'm a
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board-certified medical and cosmetic
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dermatologist in Northern California and
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I'm here to help you understand your
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skin and find products and procedures
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that work for you so if that sounds good
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give this video a thumbs up and don't
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forget to subscribe so first of all what
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are smile lines they have a lot of
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different names we call them Nas labial
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folds or Milo laal folds in the
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Dermatology office but they are
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essentially the folds or creases that
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extend from the base of your nose down
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towards the corners of your mouth I
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really wanted to address this topic of
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smile lines or nasal labial folds
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because it's one of the most common
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things that comes up in my cosmetic
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consultations with patients and it's one
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of the first things that comes up even
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for my patients who are in their 30s and
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40s one of the earliest signs of aging
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that they start to not love about their
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face is these lines and usually those
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lines aren't particularly deep at that
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point but it's the first thing that
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makes a person go o i don't love these
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changes that are happening with my face
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and I think before we dive into the ways
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that we actually treat them or improve
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their appearance it's really important
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to understand what causes them because
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if you don't understand the cause it's
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very hard to find a solution so these
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lines have a wide variety of causes a
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lot of people refer to them as smile
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lines because when you smile you can see
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where you're creating a crease and as
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you smile over your lifetime that's
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that's going to etch that into the skin
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more and we see these lines kind of
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Advance into a full-on fold as time goes
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on for several different reasons aside
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from the repeated muscle movement of
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smiling you also have the issue of
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gravity and the dissent of the facial
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tissues over time unfortunately your
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skin loses elasticity and becomes more
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LAX and as it starts to fall those lines
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get emphasized The Descent in facial
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tissues and the overall change in
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someone's facial shape is very much a
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Hallmark of getting older when you look
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at people who look youthful or you can
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easily identify that person as looking
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young they often have more volume in the
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top half of their face But as time goes
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on those tissues begin to fall and we
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begin to accumulate more fullness in the
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lower part of our face you'll notice
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jowling along the jawline and those
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nasal laal folds getting much worse but
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in addition to that volume shift we also
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have a little bit of volume loss in this
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area and I see this in women much more
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than men but as women we lose bone
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density as we get older and we actually
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lose volume of bone in our skull or in
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our face and when that happens the
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maxillary bone which is this bone that
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kind of extends here and gives you a
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cheekbone starts to shrink down and when
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you lose that volume there it actually
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loses support at the base of the nose
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and your nose starts to fall kind of
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back into your face which can really
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emphasize those lines also with regards
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to shifts in volume if you lose weight
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you often will notice an emphasizing of
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those smile lines because fat in the
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face acts as a support structure and
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when you lose that fat lines become
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emphasized I happen to be seeing a lot
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more of this these days in the OIC era a
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lot of my patients are losing weight and
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losing large amounts of weight and one
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of their biggest complaints is how much
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older their face looks and specifically
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how much more their smile lines have
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become emphasized and then of course
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aside from the volume component of your
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smile lines there's a genetic component
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so how your face ages is very much
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determined by your genetics and some
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people are more prone to developing
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smile lines than other people and of
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course I would be remiss as a
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dermatologist without talking about the
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quality of your skin contributing to
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those lines as the skin ages it's going
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to thin out a little bit it's going to
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become more dehydrated and that's going
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to make you prone to having those lines
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settle in and things that can emphasize
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that or expedite that process are UV
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radiation and smoking another important
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cause of these smile lines is something
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that a lot of people don't think about
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but when I point it out to them in
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clinic they're like oh that makes so
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much sense and that is Sid sleeping the
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reason for that is when you sleep on
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your side you kind of smash your face
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into a pillow and if you naturally have
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a crease forming at your nasal labial
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fold or along your smile line that is
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where your skin is naturally going to
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collapse on itself and it's going to
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emphasize that line while you sleep and
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when you think about it I mean depending
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on how much sleep you get that's six
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plus hours of just etching in that line
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every single night all right so we know
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all the various causes of these lines
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but what can we actually do to improve
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them let's first talk about things you
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can do at home and I would say these
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atome interventions are really there to
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help with the skin quality so rather
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than fixing really deep smile lines the
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atome interventions are more there to
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improve the quality of the skin so it's
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less prone to creasing I'm not sure I do
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a video on here where I don't sing the
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Praises of sun protection and topical
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retinoids but those are the two Holy
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Grail things that you can do for your
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skin to keep it as Supple and Youthful
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as possible and the more collagen you
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have in your skin anywhere on your face
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but particularly in this sort of like
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cheek upper lip Junction the less prone
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it is going to be to creasing and
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folding over time in terms of at home
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devices I think there a couple things
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you can think about using one is an at
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home red light LED mask now of course
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you can do red light treatments in the
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office as well but just the convenience
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of having this at home can be really
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nice I have a whole video dedicated to
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the benefits of red light so you can
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check that out but essentially we are
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using red light and near infrared light
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to stimulate collagen synthesis within
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the skin I've also had patients over the
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years who have really found benefit
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using at home devices like the new face
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or other microcurrent devices to get
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some modest tightening around their
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cheeks and jawline and anytime you are
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working to sort of like lift and tighten
05:30 - 05:34
the cheeks it's going to alleviate those
05:32 - 05:36
folds because remember it's due to
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dissent of the tissue I always remind
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people if you are investing in these at
05:37 - 05:40
home tools you have to know thyself and
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whether or not you're actually going to
05:40 - 05:44
keep up with it but two you need to keep
05:42 - 05:46
up with it in order to keep those
05:44 - 05:48
results because they are modest results
05:46 - 05:50
these are not super powerful devices and
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so it's about little incremental
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improvements every single day also for
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these smile lines I actually think this
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is a place where gacha or other forms of
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facial massage can be helpful because
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facial massage can help redistribute
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fluid in the face if you're someone who
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tends to be quite puffy that constant
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fluid buildup in the face can weigh the
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face down and start to emphasize those
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lines and so by kind of moving that
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fluid up and out on a regular basis you
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can improve your smile lines now this
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isn't going to be dramatic you're not
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going to get rid of an entire fold doing
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this but small improvements is the name
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of the game when it comes to at home
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treatments also anytime you are
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massaging or lifting up a line you're
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sort of preventing it from creasing
06:28 - 06:31
because people will be bothered by two
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different things remember the fold
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itself but also the little crease that
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gets etched into the skin and by
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stretching and moving that skin up and
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away and out of the crease you can
06:38 - 06:42
improve that speaking of those creases
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another thing that can be really helpful
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and is only going to be practical for
06:44 - 06:48
some of you is learning to sleep on your
06:46 - 06:50
back and I say this as a full-on side
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sleeper I've never been able to sleep on
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my back but if you're someone who can
06:51 - 06:56
train yourself to do it it really does
06:53 - 06:57
help with how your face ages not just at
06:56 - 06:59
your smile lines but it can help with
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chest creases neck creases there are a
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lot of benefits now if you can't sleep
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on your back and these lines really bug
07:03 - 07:07
you another thing you can think about
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doing is wearing silicone patches along
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your smile lines when you sleep silicone
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patches essentially act as a support
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mechanism for your skin so that when you
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are side Ling your skin doesn't want to
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fold or crease in on itself now there
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are brands that make specific face
07:20 - 07:23
shaped silicone patches or ones that are
07:21 - 07:25
meant for your neck or chest you can
07:23 - 07:27
totally use those usually I recommend to
07:25 - 07:28
my patients just some type of silicone
07:27 - 07:30
tape that you can get on Amazon I'll
07:28 - 07:31
link it in the description box now I
07:30 - 07:33
don't want you obsessing about things
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that you can do at home something I say
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to my patients all the time is do your
07:35 - 07:39
best but live your life and if you are
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constantly at home trying to figure out
07:39 - 07:44
ways to like Smooth out your face or fix
07:41 - 07:45
your lines or not age that's kind of a
07:44 - 07:47
miserable existence but now I want to
07:45 - 07:49
Pivot and talk about things you can do
07:47 - 07:51
in the office to improve these smile
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lines because that's often what people
07:51 - 07:55
are coming in for right away I want to
07:53 - 07:58
address the topic of using Botox in the
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smile lines every single day in clinic I
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have a patient ask me and this is not
07:59 - 08:03
their fault this is just you know people
08:01 - 08:05
don't know this stuff they ask if they
08:03 - 08:07
can use botox to fix their smile lines
08:05 - 08:09
but the reason that doesn't work is
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Botox is an injectable that relaxes
08:09 - 08:15
muscles so when we think about why this
08:11 - 08:17
line exists it's because we smile if I
08:15 - 08:19
were to inject Botox to prevent you from
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smiling you would not love the way you
08:19 - 08:23
looked it would look like you're having
08:21 - 08:24
a stroke on both sides of your brain so
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yeah by far in away the easiest way to
08:24 - 08:29
not emphasize those lines is to never
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smile but that's not really a practical
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solution and sometimes I think people
08:30 - 08:34
bring up Botox but what they really mean
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is filler so some type of injectable
08:34 - 08:39
that takes up space or volumizes the
08:37 - 08:41
tissue to sort of plump that area and I
08:39 - 08:43
want to caution about this as well
08:41 - 08:46
filler absolutely has a place in
08:43 - 08:48
correcting nasolabial folds or smile
08:46 - 08:50
lines but it needs to be done so
08:48 - 08:52
conservatively and the reason for this
08:50 - 08:54
remember is that the primary cause of
08:52 - 08:56
these smile lines or nasal labial folds
08:54 - 08:59
is dissent of the facial tissue it's not
08:56 - 09:01
really due to a lack of volume in that f
08:59 - 09:02
fold so when I'm doing some type of
09:01 - 09:05
cosmetic correction to someone's face
09:02 - 09:07
it's so important that we are only
09:05 - 09:10
adding volume back in where volume is
09:07 - 09:11
lost or where volume is missing patients
09:10 - 09:14
always say well can you just like fill
09:11 - 09:15
this up with filler oh yeah I sure could
09:14 - 09:18
with a few syringes of filler I can make
09:15 - 09:19
your smile lines completely disappear
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but when we step back and look at your
09:19 - 09:23
face as a whole will you actually look
09:21 - 09:25
better for it and this is something I
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talked to my cosmetic patients about all
09:25 - 09:28
the time any cosmetic intervention that
09:27 - 09:31
you're doing whether it's Botox fillers
09:28 - 09:33
laser tightening devices you have to
09:31 - 09:35
think about how it's going to affect the
09:33 - 09:38
entire face we don't treat features we
09:35 - 09:40
treat faces if you just go in and put
09:38 - 09:42
filler so something that takes up space
09:40 - 09:44
along those lines very quickly you can
09:42 - 09:47
start to look puffy some people will
09:44 - 09:48
describe this look as Simeon or apik and
09:47 - 09:50
there are no patients who come into my
09:48 - 09:52
office and say Dr Ellis make me look
09:50 - 09:53
like a monkey and this educational point
09:52 - 09:55
is something I always explain to my
09:53 - 09:57
patients because I think they are very
09:55 - 10:00
hopeful that they can just puff that
09:57 - 10:01
line out and it's so important that my
10:00 - 10:03
patients don't look weird I think they
10:01 - 10:05
come to me because they understand that
10:03 - 10:07
I have a very natural aesthetic and
10:05 - 10:09
they're never going to look done and one
10:07 - 10:11
of the quickest ways to look done is to
10:09 - 10:13
start volumizing lines and folds all
10:11 - 10:16
over your face these nasolabial folds or
10:13 - 10:18
smile lines are a symptom of something
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greater of the dissent of the tissue and
10:18 - 10:21
if you are not addressing that greater
10:20 - 10:23
problem and you are just treating the
10:21 - 10:24
symptom you're not going to get where
10:23 - 10:26
you want to go now I do want to say like
10:24 - 10:28
filler absolutely has a place to be put
10:26 - 10:30
along those folds but there's a
10:28 - 10:32
technique and a way that I do it so that
10:30 - 10:34
someone continues to look natural and
10:32 - 10:36
normal so it's not about completely
10:34 - 10:39
eliminating creases or Shadows from the
10:36 - 10:40
face but just lessening how harsh they
10:39 - 10:42
are now over the years there's been a
10:40 - 10:43
lot of content put out on social media
10:42 - 10:45
about well okay if you're not putting
10:43 - 10:47
filler in the nasolabial folds or the
10:45 - 10:49
smile lines should you put it in the
10:47 - 10:52
cheeks to lift the tissue up you have to
10:49 - 10:53
have an injector with such a Discerning
10:52 - 10:55
Eye to decide if you are the right
10:53 - 10:57
candidate for that in my experience
10:55 - 10:59
filler does not do a good job of
10:57 - 11:01
actually lifting up tissues but can
10:59 - 11:03
create the illusion of lifting the
11:01 - 11:05
tissues if placed properly but this
11:03 - 11:07
should really only be done in people who
11:05 - 11:09
have a flatter cheek or a less prominent
11:07 - 11:11
cheekbone sometimes I have a woman with
11:09 - 11:13
nice beautiful full cheeks a high
11:11 - 11:15
cheekbone and she goes can you just put
11:13 - 11:17
filler here to lift this up if I do that
11:15 - 11:19
you will just have alien or feline
11:17 - 11:21
looking cheeks and it's not going to
11:19 - 11:22
help your folds at all however if you
11:21 - 11:24
are someone that has lost volume
11:22 - 11:26
throughout your face maybe you've gone
11:24 - 11:28
on a rapid weight loss Journey maybe
11:26 - 11:30
you've just aged and lost volume in your
11:28 - 11:32
face replace ing volume elsewhere in
11:30 - 11:34
your face can bring more balance to it
11:32 - 11:36
and it really makes those nasolabial
11:34 - 11:38
folds or smile lines less obvious and
11:36 - 11:39
less prominent so when I'm volumizing
11:38 - 11:42
other parts of the face I'm talking
11:39 - 11:44
temples cheeks right in front of the ear
11:42 - 11:46
here there are so many places you can
11:44 - 11:47
utilize volume strategically to make
11:46 - 11:49
those smile lines less noticeable
11:47 - 11:51
without directly injecting the folds and
11:49 - 11:52
if I do that to someone and you step
11:51 - 11:54
back and you look at their face and you
11:52 - 11:56
look right at their smile lines their
11:54 - 11:58
smile lines are actually not better but
11:56 - 12:00
because we've balanced the rest of their
11:58 - 12:02
facial features those smile lines are
12:00 - 12:04
less prominent and they're not a
12:02 - 12:05
distractor or a detractor on their face
12:04 - 12:08
it's so important to see an injector
12:05 - 12:10
who's experienced but also thoughtful in
12:08 - 12:11
the way they are utilizing volumization
12:10 - 12:13
to make you look better and if you have
12:11 - 12:15
any questions about filler in general or
12:13 - 12:16
filler in the smile lines definitely let
12:15 - 12:18
me know in the comments aside from
12:16 - 12:20
traditional hyaluronic acid based
12:18 - 12:21
fillers like resellin or juviderm that
12:20 - 12:23
might be used throughout the face and
12:21 - 12:25
specifically in the smile lines another
12:23 - 12:27
thing I like to do is use Sculptra which
12:25 - 12:29
is a bios stimulatory filler in that
12:27 - 12:30
area I have an entire video dedicated to
12:29 - 12:32
Sculptra so if you want to know all the
12:30 - 12:33
details about this injectable I
12:32 - 12:35
encourage you to check that out but
12:33 - 12:38
Sculptra helps stimulate collagen in the
12:35 - 12:40
Skin So for all of my patients but
12:38 - 12:43
particularly my younger patients maybe
12:40 - 12:45
ones who are in their 30s early 40s who
12:43 - 12:48
are just starting to see that line start
12:45 - 12:49
I often will use Sculptra in the fold
12:48 - 12:51
and also kind of throughout the face to
12:49 - 12:53
help give their skin a little bit of a
12:51 - 12:55
collagen boost so that it is less prone
12:53 - 12:57
to falling and sinking over time and
12:55 - 12:59
this not only helps with the smile lines
12:57 - 13:01
but can also help prevent some of the
12:59 - 13:03
other lines and creases in sagging that
13:01 - 13:04
they will inevitably see as time goes on
13:03 - 13:06
ultimately I would say filler is
13:04 - 13:08
probably the best tool in our toolbox to
13:06 - 13:09
help lessen those lines but there are
13:08 - 13:11
certainly other things we can do in
13:09 - 13:12
office to improve the lines so I'll talk
13:11 - 13:14
about those next especially when it
13:12 - 13:16
comes to the quality of the skin and
13:14 - 13:18
early signs of that smile line getting
13:16 - 13:20
etched in resurfacing procedures to help
13:18 - 13:23
build collagen in the skin can be quite
13:20 - 13:25
helpful laser resurfacing micro needling
13:23 - 13:27
anything that we are doing to help build
13:25 - 13:29
collagen in the area can help lessen
13:27 - 13:30
that smile line as well as lines
13:29 - 13:32
throughout the face now these types of
13:30 - 13:34
procedures again are really just working
13:32 - 13:36
in The Superficial tissues in that top
13:34 - 13:39
layer of skin so they are not good at
13:36 - 13:41
helping with deep lines or folds but it
13:39 - 13:43
is not uncommon for people to come in
13:41 - 13:45
and say well Dr Ellis what about radi
13:43 - 13:48
frequency micro needling I've heard of
13:45 - 13:50
Morpheus 8 or profound or Penza and they
13:48 - 13:53
have told me that that really lifts and
13:50 - 13:55
tightens the skin well not so fast in my
13:53 - 13:56
hands and honestly when I speak to my
13:55 - 13:58
Dermatology colleagues across the
13:56 - 14:00
country like not many of us have seen
13:58 - 14:02
much extreme tightening from radio
14:00 - 14:04
frequency micro needling I have one in
14:02 - 14:06
my office I think it's amazing for
14:04 - 14:08
refining the pores and helping with acne
14:06 - 14:11
scarring and helping with texture but it
14:08 - 14:12
will not lift and tighten the skin I
14:11 - 14:14
have never seen it do that these
14:12 - 14:16
companies do an incredibly good job at
14:14 - 14:18
marketing radio frequency micro needling
14:16 - 14:19
as sort of filling that Niche because
14:18 - 14:20
everyone is really desperate for
14:19 - 14:22
something that lifts and tightens
14:20 - 14:24
because there's not much out there that
14:22 - 14:26
does that but it just really doesn't do
14:24 - 14:28
it well and I have had so many patients
14:26 - 14:30
come into my office who have spent
14:28 - 14:32
thousands and thousands and thousands of
14:30 - 14:34
dollars at outside offices doing radio
14:32 - 14:36
frequency micro needling hoping it will
14:34 - 14:38
lift and tighten their jowls their
14:36 - 14:39
marionet lines their nasolabial folds
14:38 - 14:41
and they've really seen no significant
14:39 - 14:42
benefit so I do think radio frequency
14:41 - 14:44
Micron needling has a place in
14:42 - 14:46
Rejuvenation of the skin but it's not
14:44 - 14:48
really going to be the thing that
14:46 - 14:49
changes your smile lines or the folds in
14:48 - 14:52
your face significantly now on the other
14:49 - 14:55
hand I do think skin tightening devices
14:52 - 14:57
like softwave o therapy Thermage do have
14:55 - 14:59
a small place when it comes to the
14:57 - 15:01
Improvement of these lines I find that
14:59 - 15:02
the best candidates for this type of
15:01 - 15:04
tissue tightening are people who have
15:02 - 15:06
excessive volume in the face so it's not
15:04 - 15:09
the skinny little faces they're having a
15:06 - 15:11
tiny little line it's people who have
15:09 - 15:12
heavy jows bigger cheeks that are
15:11 - 15:14
weighing down their face and creating
15:12 - 15:16
those lines because with some of these
15:14 - 15:18
tightening devices you can actually get
15:16 - 15:20
some local fat reduction if you pick
15:18 - 15:21
your settings I know people get worried
15:20 - 15:23
about using these tightening devices and
15:21 - 15:25
it causing atrophy or dying off of the
15:23 - 15:27
fat but when done strategically in
15:25 - 15:30
places where you sort of have excess or
15:27 - 15:31
irregular distribution of the fat it can
15:30 - 15:33
really help with the Improvement of the
15:31 - 15:35
smile lines as well as the gels but by
15:33 - 15:36
Far and Away the thing that is going to
15:35 - 15:39
give you the best benefit in your smile
15:36 - 15:41
lines is something that actually lifts
15:39 - 15:42
the tissue because another thing a lot
15:41 - 15:43
of patients do when they're coming in
15:42 - 15:44
and talking to me about their smile
15:43 - 15:46
lines is they do this they put their
15:44 - 15:47
hands at the periphery of their face and
15:46 - 15:50
they pull back and their smile lines
15:47 - 15:52
kind of disappear and they go I just I
15:50 - 15:54
just want that well unfortunately in
15:52 - 15:56
dermatology we don't have a ton that's
15:54 - 15:58
going to do that amount of significant
15:56 - 16:00
lifting and tightening that is multiple
15:58 - 16:02
millim me of lift if not over a
16:00 - 16:04
centimeter and nothing has been shown to
16:02 - 16:06
do that threads are something that are
16:04 - 16:09
marketed as having the ability to lift
16:06 - 16:11
the tissue and you do see it do that
16:09 - 16:12
however in my experience and over the
16:11 - 16:14
years watching people get threads and
16:12 - 16:16
then come into my clinic you get a very
16:14 - 16:18
temporary lift from threads so you might
16:16 - 16:20
look amazing for a few weeks but
16:18 - 16:22
patients end up disappointed because
16:20 - 16:23
their skin eventually and inevitably
16:22 - 16:25
sags back down quite quickly and this
16:23 - 16:27
would be fine if threads cost a few
16:25 - 16:28
hundred and weren't particularly
16:27 - 16:30
invasive but getting threads is actually
16:28 - 16:32
actually kind of a big deal and it's
16:30 - 16:34
usually quite expensive and it ends up
16:32 - 16:36
just not feeling worth it to so many
16:34 - 16:38
people ultimately the best way to get
16:36 - 16:40
rid of your smile lines is to get a
16:38 - 16:42
surgical face lift and this is something
16:40 - 16:43
that no one really wants to hear me say
16:42 - 16:44
I know you come to a dermatologist's
16:43 - 16:46
channel to be told about the
16:44 - 16:48
non-invasive things that can help and
16:46 - 16:51
I've done that but the reality is
16:48 - 16:54
because smile lines are so much driven
16:51 - 16:55
by dissent of the tissue eventually the
16:54 - 16:57
only way to fix them is to pull the
16:55 - 16:59
tissue back up where it started and if
16:57 - 17:00
there were amazing alternatives to
16:59 - 17:02
facelifts that did exactly what a
17:00 - 17:04
facelift did and improved the skin and
17:02 - 17:06
the shape of the face the way a facelift
17:04 - 17:08
does facelifts wouldn't exist but there
17:06 - 17:10
is nothing that Rivals what a facelift
17:08 - 17:11
can do and so ultimately if your smile
17:10 - 17:13
lines really bug you but I wouldn't just
17:11 - 17:15
do it for the smile lines if you're also
17:13 - 17:17
noticing lines around the face here
17:15 - 17:19
you're noticing jowling you feel like
17:17 - 17:21
your neck is sagging that's where
17:19 - 17:23
surgical interventions are really going
17:21 - 17:25
to do the most and a facelift certainly
17:23 - 17:26
doesn't last forever but of all the
17:25 - 17:29
interventions I've talked about it
17:26 - 17:30
certainly has the longest lasting effect
17:29 - 17:32
because you're really taking that
17:30 - 17:34
displaced volume and replacing it where
17:32 - 17:36
it needs to go and so many patients end
17:34 - 17:38
up in my office too and they're like
17:36 - 17:39
look Dr El I'm never getting a facelift
17:38 - 17:41
and that's that's completely fine like
17:39 - 17:43
getting a facelift is not just like a
17:41 - 17:45
normal thing that everyone goes and does
17:43 - 17:46
or can afford or wants to take on that
17:45 - 17:48
risk and like I said there are many
17:46 - 17:50
other things we can do to improve these
17:48 - 17:51
lines but there is nothing that's going
17:50 - 17:53
to give you the same result as a
17:51 - 17:55
facelift I hope this video has helped
17:53 - 17:57
you and provided you some guidance when
17:55 - 17:58
it comes to smile lines if you liked it
17:57 - 17:59
please give it a thumbs up and don't
17:58 - 18:01
forget to subscribe subscribe to the
17:59 - 18:02
channel I'm so curious if any of you
18:01 - 18:04
have tried things to help your smile
18:02 - 18:06
lines and what has worked for you so
18:04 - 18:08
please share in the comments I'll catch
18:06 - 18:10
you next time thank you so much for
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