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How Safe is Botox when Applied to the Upper Lip for Smoker's Lines?

Considering the fragility and the sensitivity of the skin area, is Botox a recommended option?

Doctor Answers 23

Botox for smoker's lines

Maybe I am just a chicken but I much prefer filler for smoker's line.  I just think that Botox in that area is too risky.  Even a little over injection can really cause a problem with a crooked smile or even trouble eating or speaking. 

I inject the individual lines with filler and then do just a little filler along the vermillion border.  I really love Prevelle for this area but most patients want a longer lasting filler such as Restylane or Juvederm.  If you have Botox, make sure you go to someone who really, really knows their anatomy.

Seattle Plastic Surgeon
5.0 out of 5 stars 57 reviews

Botox for lips

If you just want to get rid of wrinkles then Botox may help. Very few units are required. If too much is administered incorrectly, the movement of the lips will be affected and the result will look abnormal and you'll have difficulty moving your lips.

Botox for smoker's lines

In experienced hands, Botox can work very well to soften lip lines.  Depending on the patient, a combination of Botox, fillers and laser treatments will give the best result.  Hopefully, you have stopped smoking.

Martie Gidon, MD, FRCPC
Toronto Dermatologist
5.0 out of 5 stars 20 reviews

Botox for the upper lip smoker's lines

Upper lip veritcal creases are caused by multiple factors, different for every patient.  Smoking, chronic sundamage, dentition and age contribute to the lines.  Some lines have been present for so many decades that elimination of the muscle activity below the skin, which had caused the skin to "accordion" and create these lines, won't make the lines go away.  Often these stubborn lines can benefit by using Botox pre resurfacing  as an off-label indication to minimze the active pursing of the lip muscles so there is less creasing of the skin during the healing of the new skin.  The optimal resurfacing may be dermabrasion (sanding), Plasma Portrait resurfacing, Carbon dioxide laser ablative or non-ablative (Fraxel Repair), deep chemical peel, or a series of non-ablative Fraxel Restore lasers (erbium). Fillers also have been used. Some of my patients having Botox as a prelude to fillers or resurfacing did so well that they didn't need the secondary procedures.  The skin is not fragile in this location and Botox can work well. It is as said previously, is an off-label indication.  There is a risk of elongating or flattening the upper lip, asymmetry (lack of balance from side to side, e.g. a crooked smile) and difficulty eating and speaking correctly, singing difficulty and even dribbling. Very few units (1 - 2 units the most) per site injected, and maybe 4 - 6 units for the upper lip total would be used.  The lower lip can be treated similarly. You need to see an experienced physician for this treatment.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
5.0 out of 5 stars 34 reviews

Filler injections work better!

There are better options than Botox for smokers lines. I prefer either Laser of filler injections.

Botox for smoker's lines

Injecting Botox to the upper lip is considered an "off label" use of Botox.  It is very safe if the Botox is delivered in tiny amounts, strategically and symmetrically placed.  If too much Botox is injected, it may become difficult to sip from a straw, whistle, or say certain words that start with the letter "P" or "B", etc.  This is the reason it is best to seek attention from a board-certified dermatologist or plastic surgeon.

Deborah Sarnoff, MD
New York Dermatologic Surgeon
5.0 out of 5 stars 5 reviews

Fillers are best for smoker’s lines

Generally, smoker’s lines are treated with dermal filler like Restylane or Juvederm not Botox. Smoker’s lines appear due to a loss of volume in the area, so using fillers will restore the volume and decrease the appearance of the unwanted lines. In some cases, Botox can be used as well to treat the lines, but you should see an experienced injector to see what is best for your situation.


Mitchel P. Goldman, MD
San Diego Dermatologic Surgeon
4.5 out of 5 stars 7 reviews

How Safe is Botox when Applied to the Upper Lip for Smoker's Lines?

In my opinion, very safe and highly effective.  I have used Botox to soften lines around the lips and mouth for well over 15 years and I believe the results to be superior to any resurfacing technique including peels and Lasers.  You do, IMO, need to limit the amount of neurotoxin used to avoid weakening the muscles too much.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 14 reviews

Botox is one part of the treatment for smokers' lip lines

Botox, or other muscle relaxers like Dysport and the new Xeomin, are one part of the treatment of smokers' upper lip lines.  Part of the lines comes from the wear and tear of the puckering of the lips during smoking.  Slightly relaxing the muscles helps reduce the intensity of that wear and tear, which helps to slow down the worsening of the lines.  But, the lines also need to be filled in to look better; that is usually done with either Restylane or Juvederm.  Plus, the lines are usually etched into the surface of the skin, so patients usually will benefit from some type of laser resurfacing.   

There's no miracle for improving these lines, but an experienced physician who is skilled with all three types of treatment can usually help a great deal.  And most important, for the sake of your health as well as your looks, stop smoking.

Margaret Weiss, MD
Baltimore Dermatologic Surgeon
3.5 out of 5 stars 7 reviews

Is Botox Safe for the Smokers Line?

Safety is not really the issue- Botox is safe in normal doses everytime. The real question is if it is effective in removing the lines. The answer is sometimes Botox can relax smokers lines in the lip in very small controlled doses. It can make the lip look longer, so be sure to seek out a doctor with experience in injecting the lip. Some deeper lines do not respond, and other techniques such as Dermabrasion or laser might be better.

Jeffrey S. Yager, MD
New York Plastic Surgeon
4.0 out of 5 stars 61 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.