Botox or Ulthera , Which One is Better for Forehead Line and Smile Line?

Ultherapy is a process which tightens the dermal tissue by forcing new collagen and collagen remodeling which has the effect of lifting and tightening.

Since most smile lines and frown lines are a consequence of muscle activity and/or age-related collagen and fat loss, the most useful treatment is an injectable: Either Botox or Dysport to inhibit the line-causing muscle activity which is the case with frown lines and crows feet - or with the case of facial lines, an injectable to replace or stimulate collagen.

If your brow has dropped, then Ultherapy might be a good choice. (See your doctor for an assessment. Ulthera's ultrasound treatment is not surgery and can't give the same major uplift that a brow lift produces).

Botox and Dysport both are great for getting rid of, or softening, frown lines and worry lines as well as crows feet.

Thank you for your question. Botox can help with the smile lines, but I is important to define where the lines are. Some patients refer to the crows feet (outer eye skin) as smile lines and Botox is very effective here. Some refer to the nasolabial folds as the smile lines. Fillers are much more effective here and Botox is not. Botox is great for the forehead lines.  It is important to understand that Botox helps the lines by limiting the amount of muscle movement.  It's action fades over 2-4 months depending on the dose used.  Ulthera is great to add more collagen to the areas of concern.  I frequently use Botox and Ulthera together to help one's goals of facial rejuvenation.

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.