Could Botox help with skin bunching at the nose when I smile? (Photos)

Question

Hi, as you can see on the pictures, my nose looks totally normal on repose, but when I smile, there is this bump/fold (skin or muscle?) that pops out on both sides of my nose, and it looks white and unsightly. Is there any way to make this go away, e.g. with botox? And if so, exactly where should it be administered - and are there any risks? Thank you!

Behnoush Zarrini, MD · Answer

What you’re describing is often called a “bunny line” or nasalis fold. These lines or bunching appear when smiling or scrunching the nose because the nasalis muscle contracts and pulls the skin upward and inward. At rest, the area is smooth &mdash; but with expression, the folds show.
Botox (or another neuromodulator such as Xeomin, Dysport, or Daxxify) can help. A few precisely placed units on each side of the upper nose weaken the nasalis muscle just enough to reduce the bunching when you smile.
Risks to know:
Over-treating this area can cause unnatural stiffness when smiling.
If placed incorrectly or too high, Botox could affect muscles around the upper lip or under the eyes, altering your smile.
Results last ~3–4 months, so touch-ups are needed.
Key takeaway:Yes &mdash; properly dosed Botox from an experienced injector can smooth these smile-related nose folds. The placement is very specific (tiny injections along the upper sides of the nose), so you’ll want to see a provider highly familiar with facial anatomy.

Erik Peterson, MD · Answer

Hi! Dr Peterson here! Thank you for sharing your concerns and photos. Based on your description, the bump or fold that appears only when you smile is likely related to muscle activity of the nasalis or other perinasal muscles, rather than a structural issue with the nose itself. The whiteness you see is likely transient skin compression or minor blanching.
Botulinum toxin (Botox or other neuromodulators) can sometimes help: • It works by relaxing the overactive muscles that cause the bump or fold. • Treatment must be precise, targeting only the specific muscle fibers involved, to avoid affecting nasal tip movement or smile dynamics. • Typically, very small units are injected just lateral to the nasal sidewalls or along the nasalis fibers.
Risks include: • Mild bruising or swelling at the injection site • Temporary asymmetry if one side is over- or under-treated • Rarely, changes in nasal tip movement, flaring, or drooping
Because of the delicate anatomy and functional role of these muscles, it’s important to see a board-certified cosmetic dermatologist or facial plastic surgeon experienced with nasal/upper lip neuromodulator treatments. They can assess exactly which muscle fibers to target and minimize risk while improving the appearance.

Nick Slenkovich, MD · Answer

Hello! I’m Lauren, the aesthetic injector here at Colorado Plastic Surgery Center.  Yes, Botox can help with the skin bunching at the sides of your nose when you smile. This issue is often caused by overactive muscles in that area. A small amount of Botox can relax these muscles, softening the folds or "bunny lines" that appear when you smile.

Ella Fedonenko, MD · Answer

This could be corrected with injecting Botox into the dilator naris muscles by on each side of the nose. I recommend approximately 2 units of Botox on each side of the nose.

Anna Chacon, MD, FAAD · Answer

Hello, thank you for your question and for sharing your concerns.

What you are describing sounds like what we often call "bunny lines," which are dynamic wrinkles or folds that appear on the sides of the nose when you smile or make certain facial expressions. These lines are caused by the contraction of the nasalis muscle, and Botox (botulinum toxin) can indeed help relax this muscle to soften the appearance of the bunching.

Treatment Approach:

Small amounts of Botox can be injected into the nasalis muscle on each side of the nose.

The placement is very precise—typically just above the lateral aspect of the nose—to weaken the muscle enough to reduce the folding without affecting your natural smile.

Risks to Consider:

If injected too high or in excessive amounts, there can be a risk of unwanted effects, such as changes to how your smile looks.

As with any injectable treatment, there may be temporary bruising, swelling, or asymmetry.

These side effects are generally uncommon when performed by an experienced injector.

In summary, Botox is a safe and effective option for the type of skin bunching you are experiencing, as long as it is placed with precision in the correct muscle.

Michael Chung, MD · Answer

What you are describing could be related to the underlying muscles of the nose that become active when you smile. Botox can sometimes be used to soften this by weakening those muscles, but it requires very careful placement and a detailed knowledge of nasal anatomy. The main risk is that certain muscles are also responsible for helping keep the nasal valve open, and weakening them could affect your ability to breathe comfortably through your nose.
The good news is that Botox is temporary, so if you and your injector decide to try it, the effect will wear off in a few months if you are not satisfied. It is very important to see an experienced injector or plastic surgeon who understands these nuances, as the injections are highly precise.
Sincerely,Michael Chung, MDPlastic and Reconstructive Surgery

Camille Cash, MD · Answer

Yes a few units of Botox on each side of the nose can soften the effect of these "bunny lines" when you smile.  The treatment is done in the office with final results seen after two weeks.  The effect will fade gradually typically over three to four months.  See an expert injector near you for treatment.

Justin Buro, MD · Answer

Hello and thank you for your question. This is something we commonly see in our injectables practice, and it’s actually an under appreciated use for Botulinum Toxin (Botox). What you’re noticing when you smile are often called “bunny lines” - small folds or bunching of skin on the sides of the nose. These are caused by overactive muscles, most commonly the levator labii superioris alaeque nasi, which contracts when you smile or scrunch your nose. In some patients, the nasalis muscle higher up on the nose is also involved, which is why the skin may bunch across the nasal bridge as well. 
Botox is a very effective treatment for this concern. A few tiny injections (usually 2–4 units per side) can relax the muscle and smooth the area while still keeping your smile natural. Results typically last 3–4 months, and many patients maintain improvements with routine touch-ups. 
The main risk is over-treatment, which could subtly change your smile if too much product is used or if it spreads into nearby muscles. This is why it’s important to see an injector experienced with treating bunny lines and nasal wrinkles. If the folds are also due to skin texture changes or volume loss, your provider may recommend combining Botox with other treatments such as dermal filler or laser resurfacing for optimal results. 
So to answer your question: Yes, Botox can safely and effectively improve the skin bunching on your nose when you smile. With precise placement by an experienced injector, it’s a quick procedure with minimal downtime and natural-looking results. I hope that helps. 
Best wishes,Justin Buro, M.D.

Could Botox help with skin bunching at the nose when I smile? (Photos)

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