Ulthera can be used to tighten and lift the forehead which will smoothen it, but when the forehead muscle contracts, the lines reveal themselves but possibly not as much as before the treatment. Ultherapy's result may take six months to evolve. Botox remains the number one treatment for lines of expression of the forehead and crow's feet around the eyes. However, some patients can't have treatment of their forehead because their eyebrows have lowered so much that they push the upper eyelids down making folds, or hooding, and botox of the forehead would worsen this sagging as the forehead muscle won't be able to contract and elevate the eyebrows. Aside from a brow lift, Ulthera is a good consideration.
Smile folds, which run from the corner of the nose down to the corners of the mouth, are usually not treated by Botox as it can create undesired muscle relaxation of the important smile muscles and the mouth may look "stroke-like" from an asymmetric result. Some doctors do use Botox as an off-label treatment for the smile folds but there is a greater risk of this functional and aesthetic complication and it can take months to resolve itself.