Can smile lines be treated with Botox?

Patients will often ask me if I can "get rid of this line" in regards to facial lines and wrinkles that may not necessarily contribute to the appearance of age or fatigue. My strong feeling about the softening of facial lines and wrinkles is this: if it doesn't 'age' you, and it doesn't make you look tired or worried, then don't spend your hard-earned money trying to make it go away. Some lines actually do add warmth and character to the face, and an older face with NO lines usually looks a bit odd.

Some smiles that may add age to the face can be treated conservatively with Botox.

Michael Law MD

Board-Certified Plastic Surgeon

Raleigh, North Carolina

Yes, smile lines can be treated with Botox. However, it is a fact that Botox reduces muscle activity, and we need sufficient muscle activity around the mouth, so the doctor can only inject a small amount of Botox in this area, and, occasionally, the Botox injected is not enough to make a significant difference.

Importantly, it is best to have Botox injected by a highly trained physician, specifically a cosmetic dermatologist or a plastic surgeon. If you go to an experienced physician specialist, you can also have special areas treated, such as wrinkles and bags under the eyes, neck lines, bunny lines, and wrinkles around the lips and mouth (i.e, smile lines). Even a natural-looking “brow lift” can be achieved with Botox when it is administered skillfully.

Smile lines around the eyes, also known as "crow's feet", are among the best areas treated by Botox. Approximately 10 to 12 units of Botox per side are required for good correction of the smile lines.

Can Botox be used to decrease “smile lines?” Yes. Is this a good idea? Usually not.

Botox is used to decrease lines in motion, most commonly on the upper face. “Smile lines,” which most of my patients refer to as "the lines between the corners of the nose and corners of the mouth," are normally filled with “skin fillers.” Fillers include collagen, Restylane, Juvederm, Radiesse, and Artefill.

If Botox is injected to decrease “smile lines,” it will decrease “smile lines” in motion due to muscle contraction. The muscle injected on both sides is the LLSAN (levator labii superioris alaque nasii). When the LLSAN contracts, it causes a deeper “smile line.” A small dose is used to relax this muscle. Now, is this a good idea? In general, I usually do not inject the LLSAN to soften the “smile lines”. The biggest potential problem is uneven mouth movements.

Asymmetry is often the enemy of Cosmetic Medicine. Worst case scenario: you could look like you’ve had a stroke. I’ve seen good results with injection of the “smile lines” in well selected patients, including less prominent “smile lines” and a lessened “gummy smile.” Many physicians will feel uncomfortable with injecting this area, and with good reason. Usually, patients can get great results with fillers alone.

Remember- It’s Your Face! Make sure an experienced Medical Doctor treats you with Botox for best results!