Can Botox correct nose widening when smiling? (Photos)

Question

Hello:) Can Botox correct nose widening when smiling, cause the corners of my nose moves not only into sides, but also goes up. Nostrils become very big and I look angry when smiling. Also, a harsh wrinkle forms between nose and upper lip when smiling, it evens hurts a little bit. But won't Botox create even worse smile? I am also considering lip lift surgery. Could it soften that wrinkle when smiling as there will be less skin between nose and lip? :)

Monica Boen, MD · Answer

The wrinkle you are describing is a dynamic line that appears when you make certain facial expressions. This is the type of wrinkle that can be effectively treated with Botox injections that target the muscle that creates the wrinkle. Botox can also be used to minimize the appearance of nostril flaring when you smile. The best results are all in the correct dose of Botox! It requires a small amount of the medication placed just right to achieve the desired result. Make sure you work with a board-certified cosmetic  dermatologist who is also an expert Botox injector to ensure an optimal outcome.

Jason Emer, MD · Answer

It's difficult to say without the benefit of a formal evaluation. This is my expertise and a huge portion of my practice. Asymmetry is normal and expected. See an expert who does facial shaping with surgical and non surgical methods to get a comprehensive option. Best, Dr. Emer.

Kimberly Butterwick, MD · Answer

Botox, and other neurotoxins, can be strategically placed to manage nostril flaring and lip lines when smiling. Botox can be a safe and effective treatment when in the right hands and you'll have improvement for 3-4 months.  However, this is a tricky area and it requires expertise for a good result. You can maintain your results with retreatments. I recommend scheduling a consultation with a board-certified cosmetic dermatologist who can provide a formal assessment. I would start with a conservative approach to these injections, as the musculature of this part of the face is in constant motion and too much toxin will affect natural movement.

Mitchel Goldman, MD · Answer

This is a great question.  Botox ® can be placed strategically to manage nostril flaring, as well as lip lines when smiling.  I advise you to schedule a consultation with a board-certified cosmetic dermatologist, who will provide you with a formal assessment.  Botox ® in the right hands will help you achieve your goals without worsening your smile. From your photos, I can see that you may not need a lot of Botox ®, which is good news.  During the consultation with your dermatologist, I recommend discussing a conservative approach as the musculature in this part of the face are very dynamic, and the Botox ® needs to be strategically placed. You can always add more units as you go.

Monika Kiripolsky, MD · Answer

Dear AngelAng,Excellent photos! Yes, strategically-placed Botox can soften/eliminate the flaring of your nostrils when you smile as well as the horizontal wrinkle that appears on your upper lip. As with anything involving your face, please see a board-certified physician who does a lot of injectables and knows facial anatomy very well. A slow approach is key (less is more. . . then, adding a bit more after approximately 2 weeks, if needed). You definitely do not need a lip lift. The proportions of your lips and the area around your mouth are perfect. Hope this helps!Dr. Kiripolsky

Kristin M. Baird, MD · Answer

Botox can be helpful in addressing the nostril flaring and horizontal line on upper lip when smiling. Typically, only 1 unit is placed into the lavator labii superioris aleque nasi muscle on each side of the nose. This decreases the contraction of the muscle that flares the nostrils. I would recommend evaluating for nasal septum and nasal passage defects prior to this treatment. Only a very small amount is usually needed and I would recommend only adding more after a 2 week evaluation period. Please consult a physician experienced in these injections since this is a more advanced technique. Best wishes.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your photographs AngelAng. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.
It is difficult to make an assessment without a formal exam in the office where I can view the skin in multiple angles and observe wrinkles formed with facial expression. However, I hope the information provided here is useful.Although Botox is most commonly used in the upper face, it can also be used in various areas in the lower face. The nasalis muscle on the bridge of the nose is responsible for the bunny lines that are sometimes seen there when one frowns or smiles. Usually 2-4 units of Botox are used per side for this area. A different portion of the nasalis muscle is used for flaring of the nostrils. Two units of Botox can be placed in this part of the muscle to decrease nasal flaring. Botox can be placed in the orbicularis oris muscle around the lips to provide a pout to the lips and reduce the appearance of vertical lines around the lips sometimes called smoker’s lines (although they are seen in people who do not smoke as well). In this area 2-4 units are used above the upper lip and 2 units are used on the lower lip. Botox can be placed in the depressor anguli oris (DAO) muscle to elevate downturned corners of the mouth which sometimes produce a sad face appearance. In this area 2-4 units are used per side. Botox can be placed in the levator labii superioris alequae nasii (LLSAN) muscle located just beside the nose on either side to address what is called the gummy smile. The gummy smile is seen in some people whose upper lip elevates so high when they smile that the upper gums are seen in addition to their upper teeth. In this area 2-4 units are used per side. Botox can be placed in a vestigial muscle (seen in some people) called the depressor septi nasii to prevent the tip of the nose from moving downward when smiling. Here only 1-2 units is required.If I had a patient with the concern described here I would say she would be a candidate for some of the treatments described above.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
  
After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.
  
Please consult with a doctor for specific recommendations. Good luck!

Tom Jodlovich, MBBS, MPH (license suspended) · Answer

Thank you for your question and photos.
Neuromodulators such as Botox can be used to reduce or soften your nostrils from widening as well as minimise the horizontal wrinkle that appears on your upper lip when you are smiling. I would suggest to start with a small dose initially and build your way up to the appropriate dose over consecutive treatments to minimise the risk of overdoing it over a single treatment session.
I recommend that you consult with an experienced and hihgly trained pracitioner.
Best wishes.

Can Botox correct nose widening when smiling? (Photos)

Answers (8)