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?

Doctor Answers 15

BoTox gets a bad reputation when overused.

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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.  

Springfield Dermatologic Surgeon
5.0 out of 5 stars 13 reviews

Botox should be used with great caution here

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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.

Mary P. Lupo, MD
New Orleans Dermatologist
5.0 out of 5 stars 18 reviews

Botox in the nasolabial folds

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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 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.

Michael Bowman, MD
Roanoke Facial Plastic Surgeon

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Botox in Nasolabial folds and now cannot smile?

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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.

Jonathan Weiler, MD
Baton Rouge Plastic Surgeon
4.9 out of 5 stars 93 reviews

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

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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
Panama City Facial Plastic Surgeon
4.9 out of 5 stars 75 reviews

Botox into NLF lines is not a good option

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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 change again and if you've done some kind of lift, you might get a different outcome than you were intending when different muscles start moving again!

Botox Lasts Up To 6 Months

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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. 

Robert Strimling, MD
Las Vegas Dermatologist
4.3 out of 5 stars 9 reviews

Wait another month or two.

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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 different injector.

Good luck!

Don't have surgery to combat the effects of Botox

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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.




Mike Nayak

Laxmeesh Mike Nayak, MD
Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 230 reviews

Fillers better, not Botox

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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.

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.