Do you recommend Botox or fillers for my laughing lines? (Photos)

Question

I’m a 39 y/o woman who recently lost 7 kg and am going to lose 7 more. Since I’ve lost weight I’ve noticed the area around my mouth is looking deflated and the laughing lines are prominent. I want it to look fuller again and less lines but am confused as to do filler or Botox. What’s the difference? I do Botox for frown line, never done fillers. Also which should I use to make lips look fuller again? Or other recommendations?

Thomas Wright, MD · Answer

Hello! These lines that you are showing are called Nasolabial folds. The very best way to treat them is by using filler. Filler will help plump the area and decrease the indentation that you see. Most fillers last anywhere from 6 months to 18 months depending on what product you use. You can also add a little bit of Botox to the upper lip to help with what most people call "smoker lines".

Jason Emer, MD · Answer

I recommend fillers to soften the nasolabial folds themselves and also lift around the mouth and cheeks to build underlying anatomical support. In our practice we combine Sculptra with other fillers "layered" on top and lasers, skin tightening treatments such as Thermage, Fractora, and Renuvion (J Plasma), thread lifting,  and peels to get the most conservative, natural look. I suggest seeing a facial sculpting expert for a formal consultation. Best, Dr. Emer

Sam Speron, MD, FACS · Answer

Finding a permanent solution for marionette lines around the mouth and sagging facial skin is challenging. There are many options such as filler injections, chemical peels, and laser treatments.  A short scar facelift would give you a more dramatic result.  A combination of all of treatments is an option that would give you optimal results.  Treatment really depends on your specific needs and treatment will be based on your goals.

I would recommend that you see a board-certified plastic surgeon in your area that is a member of both ASPS & ASAPS and performs a lot of facelift surgery but also offers all the nonsurgical options such as injectables and laser treatments. Go over your concerns with them and make sure above all, you walk out of there with several options and an idea of the pros and cons to each of them as well as realistic expectations.

I hope my answer helps and if it does, please take a moment to up vote this answer on the “respond” button on the top right.  Have a great day.

Phillip Chang, MD · Answer

Hi sputnikcherry

BOTOX can do much more than you have ever thought.  Many people don’t realize that many of the evolution of facial aging is caused by loss of volume in the face but also by how the face muscles try to compensate for this loss of volume. To learn more about this procedure, please visit our website.

Jonathan Kulbersh, MD · Answer

Thank you for your question. Neuromodulators like Botox work on dynamic wrinkles - the lines that form when you make certain facial expressions. These lines commonly form on the upper face, which is why Botox works so well on your frown lines. Lines in the lower face, like the smile lines you have now, are typically due to collagen (or in your case, fat) loss. These creases are better treated using injectable dermal fillers in most cases. I encourage you to schedule a consultation with an experienced, board-certified injector who can assess you in person and tailor your treatment plan to your precise needs for the best possible results.

Kenneth Hughes, MD · Answer

Hello, thank you for your question. Laugh lines that form around the mouth when you smile are best treated with a filler as opposed to botox. Botox is the best for expression lines in the upper face. If used for the laugh lines around the mouth, it can cause an unfavorable change in expression and in some way an inability to smile normally.

Noury Adel, BDS, MSc · Answer

Only fillers placed in specific areas in the face may help you in eliminating these lines, further assessment and diagnosis is mandatory, you may need to have some fillers placed in your cheeks to lift it and soften the nasolabial fold INDIRECTLY, its not always necessary to directly fill these lines, and again it all depends on the case assessment.
And definitely fillers can be used to plump your lip
Wish you all the best

Dean P. Kane, MD, FACS · Answer

Dear sputnikcherry, 
Thanks for sharing these photos. They illustrate your concerns. An in-person evaluation will reveal more about the laxity, passive and dynamic movements causing these aging occurrences*.
The beginnings of facial skin laxity start at 30 years old when collagen skin repair diminishes and passive skin aging relaxes downward. The web of fibrous compartments under the skin loses fat, stretches, separates and elongates forming 5 growing “waves” of skin at points of attachment, developing:
•	hooding along the eyes,
•	lower eyelid / cheek junction or tear trough / nasojugal fold
•	nasolabial fold,
•	*lateral mouth commissure and marionette folds,
•	jowls and neck.
Maintaining a thin appearance, weight loss in addition to added sun exposure accelerate the aging process. Reversal of natural collagen reduction and volume redistribution of the face are the initial foundations of anti-aging.
I would recommend that you:
1.	Consult with a talented, Board Certified Plastic Surgeon and his team regarding non-surgical and minimally invasive options. These include:
2.	A Zein Obagi, MD, ZO Skin Health retinoid, TCA chemical peel and laser programs for external stimulation and skin tightening, exfoliation and sun-damage correction
3.	Well skilled injector for filler or fat grafting of the cheeks and beginning folds. Fillers options are changing and provide excellent line reduction and good fold softening. They add volume to the upper outer cheek to fill and lift the folding nasolabial, nasojugal and marionette skin waves.
4.	Botox  is a injectable muscle relaxer. In skilled hands, it will rebalance the brows and corner of mouth for elevation. 
5.	Sculptra is a minimally invasive injection series of bio-stimulatory filler for face and neck skin tightening
6.	Minimally invasive tightening options such as ThermiTIGHT for additional tightening. 
7.	Minimally invasive jowl and cheek lifting options such as Silhouette FaceLift suspension sutures     
8.	I believe you’ll do best with the above as a foundation prior to any surgical options.
I hope this is helpful. Stay well.
All the best!

Disnalda Matos, MD · Answer

I recommend filler .Botox I Just use for the line arround the eyes and in the forehead. I Never use botox in the midle and lower face

Camille Cash, MD · Answer

Fillers will help address the lines around your mouth and volume loss that have become more noticeable since your weight loss.  They also can be used to add fullness to the lips.  Fillers work by adding volume.  Botox works by inhibiting muscle activity.  It is useful for lines that are caused from muscle activity, such as frowning.  I've included a video explaining Botox and other neuromodulators.

Do you recommend Botox or fillers for my laughing lines? (Photos)

Answers (12)

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