The term bar code identifies those parallel-shaped wrinkles that form in the upper lip between the margin of the labial mucosa and the nose. They tend to develop slowly and progressively from the age of forty and mainly in women who often identify them as the first major stage of facial ageing. As if this were not enough, the disorder is amplified by the smearing of the lipstick in the upper margin precisely because of the presence of the bar code lines which make the border between the labial mucosa and the overlying skin uneven. The causes of their appearance are multiple and due to both skin ageing and the movements of the mimic muscles of the lip. Undoubtedly, this occurs more in constitutionally equipped subjects of a skin poor in collagen and elastin and patients who have been more subjected to the action of ultraviolet rays. As mentioned, another defining characteristic is facial mimic, in fact those who use with particular vigour the orbicularis muscle of the mouth that surrounds the lip tend to be subject to early appearance and a rapid development of the so-called bar code lines. For this last reason, it is said that smokers tend to develop these wrinkles earlier, in fact, the control of the cigarette between the lips subjects this muscle to extra work.
Effective therapies are manifold and can be modulated according to the prevailing cause and its magnitude. Hyaluronic acid fillers are undoubtedly the most used medium. In cases where wrinkles are more evident, the individual lines are filled one by one by injecting the product into a very superficial plane. If necessary, the result can be made more uniform and stable by defining the vermilion border – the lip margin at the border between the mucosa and skin – with a minimal amount of hyaluronic acid. In the milder cases, the redefinition of the border itself is sufficient to prevent the appearance of wrinkles. Injections in this anatomic area are quite painful, so normally local anaesthetic is used. When the bar code lines are very dense but not very marked, the use of laser resurfacing can be extremely effective. The more gentle erbium laser or the more aggressive CO2 allow a regeneration of the area with a drastic reduction of the signs of skin ageing; in this case, it is advisable to exclude patients with a darker complexion and to impose a complete abstention from ultraviolet rays for a few weeks after treatment. In patients in whom the dynamic component plays a significant role, it is possible to slightly reduce muscle tone with the use of botulinum toxin to support the filler or laser.