Fillers or Botox for Lines Showing Only when Laughing or Smiling?

My laugh lines are only apparent when I smile or laugh. Is it still ok for me to use Juvederm or Restylane, or do I have to use Botox?

Doctor Answers 16

Why do you want to eliminate your smile lines?

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Dear Arnj

I really don't blame you for thinking that you should have your smile lines eliminated. I think that we doctors are responsible for this type of thinking. After all, many doctors think that the purpose of BOTOX is to eliminate lines. In fact some use as their before and after picture an image of their patient wadding up the worry line area before BOTOX treatment and then being unable to make this wadding effort after treatment.

This is really a misguided concept of what this treatment is all about. The goal needs to be aesthetic improvement not line annihilation. 90% of the time our faces are at rest. The goal is improvement in lines that are present at rest not lines that are only present dynamically. The issue is that you are supposed to have lines in your face when you make expressions. When you don't people will not trust you. These lines are a critical element of how we communicate. Without the appropriate facial indicators, you will appear insincere or not trust worthy. In particular it is normal to heap up lines when we smile. This is called a Duchenne smile and it tells people that you are actually happy. When you smile and don't make these lines, the smile looks insincere-think of those fake smiles on airline attendants.

So improvement of some lines is OK but be careful of what you wish for. Don't have treatment that will make you look insincere and untrust worthy. This is why you need to go to a practitioner who knows what they are doing.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Smiles lines and Botox vs Fillers

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Thank you for your question. Botox can help with the smile lines, but I is important to define where the lines are. Some patients refer to the crows feet (outer eye skin) as smile lines and Botox is very effective here. Some refer to the nasolabial folds as the smile lines. Fillers are much more effective here and Botox is not.

Hyaluronic Acid Fillers

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Dear arnj,

Hyaluronic Acid fillers are helpful with the contours of the lips, turned down corners of the mouth, and even the vertical furrows of the lip. Fillers could be used to improve the nasolabial folds. Smokers’ lines and vertical creases around the mouth respond nicely to Restylane and Juvederm treatments. Restylane and Juvederm also smooth crow’s feet around the eyes.

I suggest you consult with a board certified facial plastic surgeon to ensure you receive the highest quality care, treatment and expertise available.

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 124 reviews

Fillers are for "resting wrinkles", Botox softens "active" ones.

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If you only see the lines/wrinkles when you are moving the muscles of your face, then weakening the muscles should soften the wrinkles...You do not say where the "laugh lines" that you want addressed are- if they are around your eyes, Botox or Dysport is appropriate, if they are around your mouth, like the nasolabial folds, then Botox is not appropriate, (it would paralyze your smile), and in this location fillers are the way to go.

Debra Irizarry, MD
Crestone Plastic Surgeon

Botox or Fillers for Lines When Smiling?

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Hi ARNJ.  The answer to your question about which product to use for your lines is dependent on the area of the face you are concerned with rather than whether or not you see the lines while you are smiling and laughing.

If you are concerned about the lines that run vertically from the corner of your nose to the corner of your mouth, then this is an area to consider Radiesse or one  the HA dermal fillers like Restylane, Juvederm or Perlane. 

If the area you are concerned with is the crow's feet area (outer edges of the eyes) then Botox is the injection product for you. 

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Treatment of laugh lines

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If you are referring to the lines near the lower crow’s feet that are noticable when you smile, Botox can help only a little as the doctor doesn’t want to make your mouth muscles go to sleep and create problems eating and with speech. Fillers may look too noticable here. A combination of conservative amounts of Botox and resurfacing, such as with Fraxel, may help but this is an area that many people just have to accept creases when they smile.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Botox or Filler

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In general I, botox is used for areas around the eyes and between the eyes and the forehead. There are some exceptions as botox can be used for neck banding and the lines around the lips.

As far as laugh lines or the lines around the corner of the mouth or the marrionette lines, the best treatment is to fill the lines with a filler like Restylane, Juvederm, Perlane or Radiesse. When I say the laugh lines, I mean the nasolabial fold.

Hope that answers your questions.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 88 reviews

Botox and fillers for lines with animation

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Botox is great for lines on your forehead and around your eyes whenever you laugh or animate these areas. However, if you use fillers for lines that only occur with animation, you may be able to see small bumps when you aren't moving those parts of your face. Check out some before and after pictures before trying either one.

Maybe Nothing At All

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If you see these lines only when laughing or smiling you may not need them treated at all. I would only bother treating lines you see at rest. You do want some dynamism of your face, smiling and laughing are good things. I would wait until you begin to notice lines at rest and in the meantime practice good skin care.

Arnold R. Oppenheim, MD
Virginia Beach Dermatologist

Botox or Fillers for Laugh Lines?

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Hi Arnj,

Botox should be used for facial lines in the upper 1/3 of the face (forehead, crow's feet, bunny lines on the upper nose) that appear with facial expression and muscle movement.

For "laugh lines" from the nose to the mouth (nasolabial folds, lines), fillers such as Juvederm, Restylane, or Evolence are best used.

Choose your injecting physician carefully.

Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.