When a Doctor Injects Botox Around Mouth for Smokers Lines, Are They Injecting into the Lips or the Muscles Around the Mouth?

I had this done once and was extremely pleased with results, then the second time(last week) had it done at the same place but by the NP instead of Dr. One side of my mouth doesn't turn up and the other does! Help.

Doctor Answers 18

Botox reduces muscle contraction around the mouth

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Botox is great at reducing muscle contractions around the mouth-- which is the cause of those vertical lip lines.  Unlike fillers which are injected into the lines themselves, Botox is injected into the muscles.  I am always very careful around the lips, a little botox goes a long way.  

Sounds like you have some assymmetry as a result of the treatment.  You may just need 1-2 units more to one side to even out the effects.  I suggest you see the doctor again to see if it can be corrected.


Dr. Margaret Mann

Cleveland Dermatologic Surgeon

Botox for Smoker's Lines.

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Botox can be beneficial to reduce prominent vertical lines around the mouth or "smoker's lines" when it is injected specifically and in small amounts. The Botox is injected into the muscle, attached directly to the skin. The direct attachment of the muscle to the overlying skin, is what allows you to pucker and purse your lips. cautious and strategic weakening of the action of the muscle with Botox treatments lessens the prominence of the vertical lines, but over-treatment can lead to lip asymmetry and inability to adequately close your mouth.

Vertical lip or "smoker's lines" are best treated with judicious use of Botox combined with a dermal filler or TotalFX fractional resurfacing for long lasting results.

With the asymmetry you are experiencing now, your best option is to wait for the Botox effect to wear off and explore having the physician inject the next time, use dermal filler only or opt for TotalFX fractional resurfacing.

Botox for lip wrinkles

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it must be understood there are certain rules:

1) your doctor must stay close to the wet border,.....inject into the muscles on the skin side of the wet border

2)  do not inject near the corners of the lip

3)  doctor should inject i/2 and 1 inch out from the center of the lip on either side

4)  use 1-2 units per site

Arnold W. Klein, MD (in memoriam)
Beverly Hills Dermatologic Surgeon

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Botox around the mouth

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When a doctor injects Botox around the mouth for smokers' lines, it is injected into the upper lip skin portion (the "mustache" area).  If you look in the mirror and purse your lips, you'll see those pesky lines.  Tiny needles are used to inject into the lines or to the side of the lines.  The injections do not got into the lips themselves.

Deborah Sarnoff, MD
New York Dermatologic Surgeon

Botox for smoker's lines around the lips

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As others have noted, the neuromodulation effects occur in the muscles responsible for the unwanted lines.  Around the mouth, the relaxation can lead to weakness of contraction which will soften the harsh lines.  This may also create the inability to pucker, kiss, whistle, suck through straws, and may even affect speech and enunciation.  Some patients report enough dyskinesis (uncoordinated movement) to bite their lips inadvertently.  Your physician may be very experienced and best qualified to have you reach the right effects in this area.  Otherwise, be aware of the potential risks and wait out the complications. 

Botox in the Perioral Region

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Botox is always injected into a muscle, unlike artificial fillers that are injected into soft tissue.  Botox is a neuromodulator, and its action targets muscle activity, specifically weakening target muscles to attain the desired aesthetic improvement.  Perioral rejuvenation with Botox requires a very experienced injector, and should be initially injected in small quantities to prevent complications and establish a baseline for future injections.  To treat "smoker's lines" Botox is injected into the upper lip. By relaxing the upper lip Orbicularis Oris muscle Botox reduces the appearance of "smoker's lines".  Botox can also be injected into the lower lip Depressor Anguli Oris muscle reducing the downward pull of these muscles creating a turned-up corner of the mouth.  It is possible that your injector did not satisfactorily target the appropriate muscle, and therefore you did not achieve the desired elevation to the corner of your mouth.  I suggest you follow up with the practitioner and voice your concerns..... Dr. Corrado

Anthony Corrado, DO
Philadelphia Facial Plastic Surgeon
4.9 out of 5 stars 40 reviews

Botox can be very helpful for treatment of "smoker's lines" around the mouth

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Botox can be very helpful for treatment of "smoker's lines" around the mouth. The main risks include asymmetry (more/ less effect on one side) and involvement of muscles that the injector did not intend to weaken. That is likely what is happening in your case as you've noticed some difficulty elevating one side of your mouth. The upside is that this effect is temporary and will wear off. I would recommend returning to your injector to mention your concerns. It is possible, in certain cases, to inject a small amount of additional Botox to provide summetry or just wait until the effect of the Botox dissipates. These injections are always performed into the muscle surrounding the mouth as opposed to the body of the lip itself.

Stephen Weber MD, FACS

Botox can soften lines around the mouth

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  I have used Botox to soften unwanted lines and wrinkles of the forehead and face, including around the lips for over 20 years.  When using Botox to soften 'smokers lines", IMHO, you need to decrease the number of Botox units used to avoid over-weakening the lip muscles.  The first time is a learning curve, for each patient and once the exact location and amount of Botox units is established, this needs to be repeated by whomever does the injection...RN, NP or MD.

Botox Can Be Very Tricky to Use For Lip Wrinkles

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I agree that Botox can be quite tricky to use on the lips and that hyaluronic acid fillers such as Juvederm and Restylane are much safer and more effective for lip rejuvenation. When I do use Botox for lip lines I start with extremely small doses first to judge the response. These injections have to be done carefully and symmetrically by someone with a great deal of experience. As always, please remember your results will depend upon the skill and experience of the physician who injected you.


Botox can be useful to address smoker's lines

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Botox, in small amounts, can work well to reduce “smoker’s lines” when injected appropriately around the lips. Since Botox is intended to soften the fine lines caused by muscle movement, it needs to be injected to the “white lip” and not into the actual “red lip.” Depending on the amount of Botox that was injected, the asymmetry may improve slightly over the next few weeks. I would make an appointment to see the physician and discuss your concerns. Good luck!


Beverly Hills, Los Angeles

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.