Can the puckering effect, noticeable indentations when speaking and eating, be lessened with Botox?

Question

I am a 50 year-old female and am very self-concious about the aging look around my mouth. I also have wrinkles as well. I understand that lines and wrinkles cannot be treated with Botox, but can the the mouth movement that accentuates the indentations when puckering, eating, et cetera be treated?

Melissa Chiang, MD, FAAD · Answer

Botox can soften the dynamic wrinkles that occur when you pucker your lips.  Botox in the upper lip can also evert the lip, which makes the lip appear fuller, even though we have not increased its volume.  Many people, especially young people, love the results.In older patients, we need to be more cautious since Botox can flatten the philtrum and length the upper cutaneous lip.  This is an effect that we want to avoid, since the aging cutaneous lip is already too thin and long.  We tend to use very minor dosing in the upper lip.  My typical starting dose is 2 units.  I will increase to as much as 8 units, if the patient tells me that they are not having any side effects (eg difficulty articulating) and they want a stronger result.

Kristin M. Baird, MD · Answer

Yes, Botox can be helpful to soften the lines around the mouth that are more prominent during animation. In addition to Botox I would recommend filler for these lines to smooth out the skin and give support under the lines. The filler will also enhance the effect and duration of the Botox. The newer filler, Restylane Silk, has shown very nice results with these lip lines. I would recommend consultation with a board certified dermatologist or plastic surgeon who is experienced in aesthetic injectables around the mouth area since this is a more advanced area for Botox/filler. Best wishes.

Manish H. Shah, MD, FACS · Answer

Hello Candylady50,Thanks for your question.The best way to think about aging around the mouth is to envision a beachball all filled with air.  As you let out the air, the beachball collapses and has folds and wrinkles.  It is this loss of volume that we see as aging around the mouth.  Botox can help soften the dynamic component of mouth motion, but you still need to restore volume and improve the skin.  Injectable filler material and fat grafting can revolumize the mouth.  The skin can be treated with laser resurfacing, IPL, ultherapy, microneedling, RF energy devices, etc.An evaluation by an expert in the management of the aging face is necessary to determine what path would help you best.Good luck,Dr. Shah

Jason Emer, MD · Answer

I suggest seeing a cosmetic dermatologist for an evaluation. there are many treatment options that you will likely need in combination for the best outcome.  This is not a single treatment for improvement, but more a long term plan.  Best, Dr. Emer.

Lorrie Klein, MD · Answer

While it is not an FDA-approved use, small doses of Botox can lessen lines and puckering around the lips.  Too much can cause problems with eating and talking, as well as drooling so make sure you go to a cosmetic dermatologist or a plastic surgeon (if the plastic surgeon does a lot of Botox treatments him or herself) and is experienced treating lips.

Dean P. Kane, MD, FACS · Answer

Dear Candylady50:Puckering or pursing a round muscle is the body's way to close the opening. This is the way the eyes, mouth, anus and vaginal openings close. They each create radiating lines of skin pleating like the rays of the sun; and so it is with the lips. Current techniques use Botox or other muscle relaxers in a very sparing manner to control the muscle and thereby reduce the ability to crease the skin which create wrinkles. Other options use thinner fillers to smooth upper lip lines like Restylane Silk. For many a patient, the pink lip is similarly thinned or atrophic and a more volumizing and projecting filler such as Restylane or Juvederm help plump and fill these wrinkles too. Sculptra is yet another consideration. While FDA listed as a filler it works more as a bio-stimulator of collagen, hyaluronic acid, elastin and other skin firming molecules. This will help resist wrinkles as the circular muscle creates them. It is best to consult with a expert injector with aesthetic training such as a Board Certified Plastic Surgeon, Facial ENT or Dermatologist. I hope this was helpful. All the best!

Susan Van Dyke, MD · Answer

We often use Botox to reduce muscle movements that are not unattractive and unnecessary.  Excessive puckering of the mouth can safely be reduced with small amounts of Botox placed carefully.  Beware though, too much Botox can result in difficulty with pronunciation of p's and b's.  Another area that can benefit is the chin.  Muscles attach to the skin at the chin and can become overactive and asymmetrical.  A small amount of Botox can give a very pleasing result.These are all considered "off label" and are not FDA approved. Only licensed professionals with a great deal of experience should treat these areas.

Hratch Karamanoukian, MD, FACS · Answer

Thank you for posting your question. it helps guide a lot of patients who have 'puckering' and 'indentations' and 'smile lines' that they desire to be corrected.I hope you had posted pictures as it would have helped provide you guidance.Nevertheless, there are a lot of things that can be done for fine wrinkles, dermal grooves that have been accentuated with aging and volume loss, and also with laxity of the skin that comes with the aging process and loss of collagen in the skin and its supporting structures.Seek someone who can give you a comprehensive treatment package including Botox, fractional lasers, dermal fillers, RF and/or Ultherapy technology, among others. You can start with a good retinoid product called RR Retinoid Repair cream to enhance the appearance of your skin and which will get rid of some of the fine wrinkles and blemishes.

Lawrence Osman, MD · Answer

Botox can be injected around the mouth to reduce puckering movements that accentuated wrinkles around the mouth.  In patients with very early and subtle wrinkles, it can sometimes provide enough improvement by itself.  However, to optimally treat more advance wrinkles, people often need a combination of treatments including Botox, fillers, and possible fractional resurfacing.

Can the puckering effect, noticeable indentations when speaking and eating, be lessened with Botox?

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