What the research shows
Ablative treatments, which remove the top layers of skin, give the largest change. Early CO2 laser series showed large improvement, best around the eyes, with redness lasting about two months and temporary darkening in some patients (Alster 1996). In one large practice, mild permanent lightening of treated skin occurred in about 1 in 25 (Roberts 1997). In a randomized trial, the CO2 laser removed more lip lines than intense pulsed light and had more side effects (Hedelund 2006).
The older methods still hold up on the upper lip. A deep phenol peel smoothed upper-lip lines more than the CO2 laser (Chew 1999). Dermabrasion matched the laser with less pain and faster healing (Holmkvist 2000). Around the eyes, the CO2 laser did better than a medium-depth peel and left redness longer (Reed 1997).
The erbium laser heals faster. Crusting lasted about three days after erbium against about a week after CO2, though CO2 removed more lines at the usual settings (Newman 2000). Set to the same depth, the two lasers gave the same result (Ross 2001). Erbium results around the mouth held at about a year, with no lightening of the skin (Sanniec 2019).
Many patients have lip lines treated during the facelift. A phenol-croton oil peel around the mouth at the time of a facelift reduced lines, lowered apparent age and left patients highly satisfied (Ozturk 2013). Laser on skin that was not lifted was safe during a facelift; laser on the lifted skin flap risked loss of skin at its edge (Brackup 2002).
Cold sores can flare after a peel or dermabrasion around the mouth, even in patients with no history of them. Antiviral medicine started before treatment prevented outbreaks, and the authors advise it for every patient (Perkins 1996).
Where surgeons disagree
- Laser or dermabrasion for the upper lip. Two side-by-side trials found no difference in lines (Holmkvist 2000, Gin 1999); a third found a small laser advantage, and most patients picked the laser side as the better result (Kitzmiller 2000).
- CO2 or erbium. CO2 removed more lines with longer crusting in one trial (Newman 2000); when the injury depth was matched, the difference disappeared (Ross 2001). In that trial, treatment depth set the result more than the type of laser.
What is new
- Non-ablative fractional lasers and heat devices give moderate improvement around the eyes, and most patients return to work and social life in two days (Salameh 2022).
- These gentler lasers worked in patients 45 and older and did not clearly help younger patients (Jia 2025).
- In Asian patients with medium skin tones, a non-ablative erbium protocol softened lines around the eyes without dark spots (Wu 2026).
- A phenol-croton oil peel with a facelift also shortened the upper lip, the area between nose and lip, by a measurable amount (Janssen 2026).
What is still unknown
- How long the gains last: most comparison trials follow patients for a year or less (Hedelund 2006, Holmkvist 2000).
- Safe settings for darker skin: patients with pigmented skin are under-studied, and the first protocols for them are recent (Wu 2026).
Key papers
- Alster 1996: early CO2 laser series that set expectations for redness and temporary darkening.
- Perkins 1996: antiviral medicine before perioral peels prevents cold sore flares.
- Chew 1999: a deep phenol peel beat the CO2 laser on upper-lip lines.
- Holmkvist 2000: dermabrasion matched the CO2 laser on the lip with an easier recovery.
- Newman 2000: erbium heals faster than CO2.
- Ross 2001: at equal depth, CO2 and erbium give the same result.
- Brackup 2002: where laser is safe during a facelift and where it is not.
- Ozturk 2013: facelift plus perioral phenol-croton oil peel.
- Janssen 2026: the same peel shortens the upper lip.