Botox for Nasolabial Folds and it's Been 5 Months and I Still Can't Smile?

I had 15 units of botox in November 2011 above the nasolabial folds and next to each nostril to reduce my deep smile lines. I could not smile at all after that. My upper lip would not move and you could not see my upper teeth. It is May 2012 now and I still cannot smile yet. Is that normal after 5 months for botox not to be gone? Should I consider a lip lift or midface lift?

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14 Doctor Answers | Asked by ntiniaj

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Botox should be used with great caution here

There is a place for Botox for nasolabial folds, but 15 units is way out of the norm and clearly demonstrates a lack of understanding of how to use Botox. Dermal fillers are optimal in the nasolabial fold. There are certain patients however, that do benefit from 1-2 units at the peak of the fold to relax a muscle that pulls the lip up into a snarl. The ideal patient should have full lips and a short distance from the upper lip to the nose, since this injection lowers the upper lip and... more

Botox in the nasolabial folds

The nasolabial folds and the area around the mouth is a very sensitive area and botulinum toxin (Botox, Dysport, etc) must be used with caution in that area. Botox usually lasts 4-6 months...so because you received a higher dose in a sensitive area, I would still recommend watchful waiting. Most likely another 4-6 weeks and you will start to see your movement return. I would definitely not recommend any surgery for now. Botox is a safe and predictable medication,... more

Botox in Nasolabial folds and now cannot smile?

I agree with another post. Botox is not a good option in this area. Fortunately the Botox will wear off and things will soon return to normal. I advise a filler in this fold and results will be natural and longer lasting.

BoTox gets a bad reputation when overused.

The effects of BoTox are dose-dependent with durations lasting from 3-6 months. In the lower face, the muscles are complex and even a small dose of Botox can have a long-lasting effect. Botox should be used very cautiously here and in expert hands. Even after Botox effect of paralysis/weakness has abated, muscles have not worked together for a long time synergistically and a normal smile can take longer.

Botox is not used for nasolabial/smile lines, dermal fillers are.

Botox is not the appropriate treatment for the nasolabial/smile lines. It will cause smile abnormalities as you are pointing out. Botox should wear off by 5-6 months at the latest. Do not get surgery to correct. I will sometimes put a very small amount of botox in the area near the nostril for someone who has a gummy smile, but doses are much less.

Steven F. Weiner, MD

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Pensacola Facial Plastic Surgeon

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Botox into NLF lines is not a good option

Botox is temporary and that's the good and the bad. This type of treatment is very, very finicky and in my opinion, it's just not a good place for Botox for the precise reasons you stated. Fillers into the NLF lines are much better, and more natural. The Botox should wear off over the next month or two, as it just doesn't have that long of a lifespan. Doing any kind of lip or midface lift is actually a bad option because when the Botox does wear off, your facial structure will... more

Botox Lasts Up To 6 Months

Botox and Dysport typically last 3-6 months. So, I suspect that your undesired Botox effects should wear off within the next 4-6 weeks. Surgery is not indicated.

Wait another month or two.

Firstly, I regret that you are having to go through this. 15 units is a lot for the nasolabial folds. The typical dose would be 1 -2 units, not more than that. While most physicians prefer not to use BOTOX at all for the nasolabial folds, some of us have seen good results - but the dose has to be kept to a minimum. Since BOTOX effects do play out over 4 -6 months, I am hopeful that yours will wear out too. DO wait a month or two, before considering other options. And yes, do consider a... more

Don't have surgery to combat the effects of Botox

The best - and the worst - thing about botox is that it's a temporary treatment. Continue to wait it out - it may take over 6 months to fully resolve in the middle and lower face. Surgery, with its permanent changes, and risks, is not indicated. Best, Mike Nayak

Off-label use of Botox or Dysport for smile folds

15 units appears to be quite high for the location near the nose as the desire, in this off-label use of Botox or Dysport, is to only partially relax the levator muscles of the upper lip and corner of the lip so that the fold flattens. However, if the dose is high for your facial anatomy, the effect may be too strong and last longer. Sometimes Botox's effect is seen to last close to 6 months, such as in the neck bands, and for hyperhidrosis (sweating) so give it more time, even up to two... more

Botox Not Best Treatment for Nasolabial Folds

The effects of Botox can last up to 6 months, so your muscle movement should return in the next 4 weeks. Additionally, in echoing some of the other posts here, Botox is not the proper treatment for nasolabial folds. Botox is excellent for crow’s feet and lines in the forehead, but for smile lines, injectable fillers like Juvederm or Restylane are the way to go. see video

Botox for nasolabial folds

Greetings~ Sorry to hear about your unfortunate Botox experience. I most certainly agree with the other responders in that Botox is not a great option for treatment of the nasolabial folds. (Especially in such a high dose) Fillers in this area are much more effective with much lower risks and often(in the case of hyaluronic acid fillers) reversible. Though it has been 6 months it may still take some time for the Botox to wear off completely so don't consider any surgical... more

Botox for Nasolabial Folds

Sorry to hear about your negative experience. Botox is not a good option in the nasolabial folds. Dermal Fillers produce much better results for this area. 15 units is far too much. It demonstrates the need to utilize only an experienced and expert injector. Most likely you will start experiencing improvement in 4 - 6 weeks. Surgery is not indicated at this time.

Botox and nasolabial folds

Botox is not my treatment of choice for deep nasolabial folds because it can affect your smile. I prefer to use fillers in areas around the naslolabial folds to improve their appearance. As opposed to most injectors, I rarely place filler products directly in the naslolabial folds. I place filler in specific fat pockets of the face around the nasolabial folds to give a natural look. It can between 3-6 months for the full effect of Botox to wear off. For now, I would... more