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

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

Botox is injected by many doctors into the skin above the muscle, but some inject it into the muscle. It also depends on where on the face the injection is to take place and the concern of bruising.  The exact location and number of units is more of an issue as the muscle underlying the skin insertion will ultimately be affected whether it was injected directly or affected by the proximity of the placement.

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