Around the mouth, upper lip and smile lines. How many units do I need? (Photo)

Lips require fillers, lasers, microneedling and PRP.  Botox has very little use here.  Best, Dr. Emer.

Lines around the mouth are usually treated with filler, not Botox, so units don't really apply. You have relatively deep lines around the mouth, as well as lines in the cheeks. I'd recommend an evaluation by a surgeon that specializes in facial rejuvenation so you can discuss all of your options. At the very least, you will need multiple syringes of filler to get an appropriate improvement. An aggressive laser treatment may be a better long term option for you. Andrew Campbell, M.D.Quintessa Aesthetic Centers

Hi,You need more dermal fillers to help correct the issues you are concerned about. These products help fill and plump up the face after facial fat loss over the years.

While small doses of botox can be used to weaken contraction of the sphincter muscles around the lips, this will not affect the static wrinkles, noticeable in photos and when your muscles are at rest.  These are best treated by resurfacing (lasers, chemical peels, or dermabrasion) and fillers.  Several small particle fillers have been developed to try to efface these fine lines (Belotero, restylane silk).   Consider a formal consultation with a Board Certified surgeon to discuss your options.  Best of luck.

Thank you for your question and for sharing your photograph.  Botox works best on dynamic wrinkles, those that develop as the underlying muscles of our face move.  The wrinkles you are most concerned about appear to be static wrinkles, present even without animation and would best be treated with dermal fillers, as wound your smile lines where are facial creases and not wrinkles.  Depending on your desired cosmetic appearance I would recommend a full face and neck lift, but if you are uninterested in surgery you can achieve a less dramatic improvement with fillers.  Hope this helps.

In general, for "smokers lines", or vertical wrinkles around the mouth, expert Botox Cosmetic® physician typically inject 3-8 units, as more than this can compromise the delicate functioning of the mouth muscles for speech/eating and drinking. As a result, this area may require more frequent treatment, up to every 6 weeks or so. Since injecting Botox Cosmetic® around the mouth is an advanced procedure, please consult a board certified aesthetic dermatologist for a consultation.   

Botox for lip lines is a very short duration of improvement. Expect about 8 weeks improvement with 3-5 units. I would suggest at the minimum to combine with an HA filler. Other treatments such as lasers or Infini will give longer results.Smile lines need filler to improve.

This question is very common from patients, however it is more important to understand if a treatment is appropriate for someone. Botox is FDA approved for treating dynamic wrinkles (skin lines perpendicular to the action of underlying facial muscles) and only for frown lines and craw's feet. All other areas are considered off label. Static and deep wrinkles can improve with fillers. Moderate static wrinkles with little skin laxity may improve with peels or laser resurfacing. Deep wrinkles with significant skin laxity will improve with a face lift.

Fillers provide the best results for lip lines (I like Silk or Belotero), but you can use Botox/Dysport/Xeomin around the lips. There is a fine line between getting a good result and getting side effects in this area! I start off using 6 units - 18 units of Dysport-  divided in to 4 injection sites. Sometimes this will not completely eradicate the lines, but it will make them look softer, and it will make the lips look a little larger, which is a nice side effect. The down side to this treatment is if you get too much you can feel it: it is hard to suck through a straw or whistle or blow out candles... The only other down side is that it only lasts 2-3 months because you can't use enough product to make it last longer or you will have side effects. If your injector charges by the unit, this isn't a pricey treatment, so it's worth a try, but you might be happier with filler.

Thank you for your question pat duffy. Botox is a purified protein used to address wrinkles associated with facial expression. The pivotal studies demonstrated that a dose of 24 units in the crows feet around the eyes are enough to allow most people to enjoy their results for 3-4 months. There have been no studies in the lower face. Very small amounts are used around the lips (4-8 units). Too high a dose can interfere with eating, speaking, and breathing. For those with deep wrinkles at rest fractional CO2 resurfacing can provide more benefit. Please consult with a doctor for specific recommendations. Good luck!