A difficult patient at a cosmetologist appointment: early lip changes in women smokers: causes, and methods of correction

A smoker’s lips are more likely to change because of exposure to reactive oxygen species that contain oxygen in large quantities in tobacco smoke. Oxidative stress is a crucial factor in the development of smoking-related diseases, such as oral cancer, lung cancer, and chronic obstructive pulmonary diseases. The damaging effect occurs because of the imbalance between the generation of reactive oxygen species and their detoxification. Markers of oxidative stress include parameters of lipid peroxidation, the activity of glutathione and antioxidant enzymes, and oxidative DNA damage. The destruction of hyaluronic acid (HA), the only drug used to correct lip changes, in smokers is accelerated by its participation in reactions with active oxygen forms, and not just by pathemization because of enzymatic cleavage by hyaluronidase. Mannitol has strong antioxidant properties, which makes it an ideal auxiliary substance in the composition of fillers based on HA. The role of reactive oxygen species in the aging process and their effects on both endogenous HA and HA-based drugs developed for esthetic use are discussed. A review of drugs, based on mannitol with hyaluronic fillers, is provided. The inclusion of mannitol in hyaluronic fillers is an effective and safe way to improve both short-term and long-term esthetic effects of the HA injection.