Too Much Botox in Smokers Lines - No Movement, Cannot Speak Properly

Hello and thank you for the question.

To address your concerns, the management of smokers lines typically involves a tripartite treatment and especially in patients who have static peri-oral rhytids. The first step is to minimize the rhytids through a resurfacing technique. You have several options at your disposal including a chemical peel, dermabrasion, and fractionated laser resurfacing. Once the skin is resurfaced and a stable state is established, any residual rhytids that persist can be addressed with use of a filler. My preference is to use Juvederm which is applied over several treatments using different injection modalities to effect an optimal result. Lastly, Botox or any comparable chemodenervation agent can be used to soften the lip lines by weakening the peri-oral musculature. As some of my colleagues mentioned, it is best to use less Botox in the lips, especially on first treatment, in order to avoid over-correction and a "frozen" lip, which can potentially take several weeks to resolve.

Best of luck,

Glenn Vallecillos, M.D., F.A.C.S.

Perioral radial lines [vertical lines above and sometimes below the lips] are sometimes known as "smoker's lines" [and they seem to be more common in smokers, because smoking accelerates aging of the skin, so that smokers might get the lines perhaps ten years before an identical twin who did not smoke. The lines are more common in women, perhaps because women have thinner skin than men, and perhaps because a man's whiskers provide some structural support to his skin, kind of like the way rebar reinforces concrete.

Perioral radial lines can be treated in a number of ways. If the lines are early in their development, and are visible only when the perioral mucles contract and purse the lips, relaxation of the perioral muscles with BTX-A [for example, three doses of one unit of BOTOX® about 3-4 mm above the vermilion border, at a depth of about 2 mm, into the lateral and middle thirds of the lip, and perhaps also two doses of one unit of BOTOX® into the middle of each half of the lower lip, 3-4 mm below the vermilion border, can produce a pleasing degree of relaxation of the lip. There is sometimes also an attractive slight eversion of the treated lips, resulting in slightly enhanced show of the vermilion of the lip.

Rarely, it is desirable to increase the dose of BTX-A, but ONLY after the patient has had experience with the more moderate dose described above.

Treatment needs to be repeated every 6-8 weeks in most individuals to maintain the desired effect. Higher doses would last longer, but will often produce an excessive and undesired degree of relaxation of the lips for the first month or so.

Where the lines are present even at rest, it is often desirable to refill the lip. I like to use Juvéderm Ultra XC for this purpose. After ice to the area for sixty seconds, to produce anesthesia and also vasoconstriction [Smith KC: Ice Anesthesia for Injection of Dermal Fillers. Dermatologic Surgery 2010(S1):812-814.] linear threads of Juvéderm are injected parallel to the vermilion border, at a depth of 1-2 mm, about 4-5 mm above the vermilion border of the upper lip, and the same distance below the border of the lower lip. Sometimes a second row of linear threads are injected about 1 cm superior to the vermilion border of the upper lip if the lines are quite long. Usually a total of 0.85 ml [one syringe] of Juvéderm Ultra XC is sufficient to treat the upper and lower lip. Occasionally the treatment is repeated in a month or two. It is wise to hold firm steady pressure on the treated area for ten minutes immediately after the needle comes out of the skin, to reduce the incidence and severity of bruising.

Fractional ablative laser resurfacing [for example, using the Cutera Pearl Fractional laser, or similar equipment] can be helpful for perioral lines. Treatment may have to be adminstered two or three times to obtain maximum improvement in some cases.

In other cases, resurfacing by the use of TCA or phenol peels can be very effective.

BTX-A, fillers, laser and peels can of course be combined, depending on the patient's needs.

To preserve the benefits of treatment, the patients should be encouraged to protect themselves from UV damage and to avoid smoking.

If you’ve had too much BOTOX in the smoker’s lines it will get better. It’s not a question of price of the number of units. You get different result from doing filler for the smoker’s lines versus BOTOX. The results from filler are more long lasting, depending on how it’s done.

one should give 1 unit at 1 cm intervals along the edge of the lup for 4 sites mesuring out from the middle of the lip. To get a good spread take 4 units and dilute it to a total icc fluid. then inject 0.25 cc at the 4 sites at the lip edge. 2 sites on the right and 2 on the left. People wil still have problems is s and p pronunciation for a week

No worries, the botox effect will begin to lessen. Often for the first week or two movement can feel funny. Lip lines are challenging. Because they are caused by muscle movement , botulinum toxin injections are one means to work on them.

 Fillers are the other option, and sometime I will use them both. Laser resurfacing if you are fair may be a longer term option as well.

 Hang in there

It is possible that you were over-injected, but it is a little unusual that you would be experiencing such dramatic changes at 24 hours.  It usually takes a little longer than that.  That could be good or bad for you.  Some of our patients report a feeling of numbness and heaviness on day one that resolves over the coming days.  If that is your case then your results may still be OK.  If however you have only partial onset of the results and they are going to increase over the next few days the symptoms may get worse.  Luckily whatever the result it will be temporary.  In regards to your overall question, botox is rarely the answer for smokers lines.  It is a good treatment in addition to fillers or skin resurfacing, but rarely suffices by itself.  That may not be that good of news either, but at least its honest. 

I would agree with the other physicians and say that you were probably over-injected in your lips.  The good news is that the effects should resolve; the bad news is that it may take several weeks to a month for this to happen. 

Some injectors have actually gone back and added a little filler to the lips to increase stiffness which may help.  Otherwise, the only thing to do is to be patient and let it wear off.

I hope that helps!

You were over injected. Unfortunately, the results around the mouth can last LONGER than the results on the upper face. You can expect it to get worse over the next 2 weeks and last for a couple of months. Resurfacing with minimal Botox (4-8 units) gives fabulous results. Filler is always safer in this area for people who speak or play instruments for a living.

G'day Hails,

The lip should only recieve about one unit of Botox in each of the four quadrants for the treatment of smokers lines.  Even at top price, 4 units of Botox may run about $60.  Sounds like you have been given too much Botox in your lips.  Unfortunately nothing to do until it wears off, but should give you ample time to find an injecting physician who knows what they are doing.

Good luck and be well

Dr. P