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

This area would be treated well with fillers, another injectable treatment. Fillers add volume to smooth away creases around the mouth. Botox is not ideal for this area.

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 months as it is expected  to see improvement. Do do anything surgical now.

 

The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs. If you are experiencing a medical emergency proceed to your nearest emergency room.

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.

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 recommend speaking with your physician regarding his/her recommendations.

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 options or interventions.  Botox is temporary...surgery is not. Hang in there.  It will resolve.

Good luck~

Dr. Grant Stevens

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.

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 flattens it bit.

In spite of this lack of judgment of one doctor, don't do surgery. It will eventually go back to normal. Botox in the lower face always lasts longer than in the upper face and is another reason for this being an expert only injection.

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, but most of the safety involves the skill of the injector.  In general, "safer" areas for botox are for the upper 1/3 of the face.  In the lower 2/3 of the face, fillers are best used for rejuvenation.

 

Hang in there.  If you continue to have problems after 6 weeks or so, I would make sure your injector knows about the problem, but I would also get evaluated by another qualified facial plastic surgeon in the area.

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.

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.