Large dents starting from the side of my nose over to the apples of my cheeks - will Botox fix this? (Photos)

Question

Hi I'm wondering if anyone could help me getting rid of my biggest insecurity. I have had botox in my forehead and crowsfeet for the last 5years but the rest of my face seems to be even more active or contracting eversince. I never seem to relax the rest of my face. When i do a simple smile, i get really tense in my cheeks which creates large dents starting from the side of my nose over to the apples of my cheeks. How can this be avoided? Botox or filler?

Tania Hassanzadeh, MD · Answer

Hi there,
Thanks for your question! If I understand your problem correctly, you are noticing more pronounced activity of the "nasalis" muscle that runs over the sides of your nose when you smile. This can be common after Botox injection to your forehead and crow's feet! Fortunately, it is easily corrected with Botox to the nasalis muscle, which causes so-called "bunny lines", for relaxation and balancing.
Hope this helps!Dr. H

Raffy Karamanoukian, MD, FACS · Answer

Non-surgical options for cosmetic dermatology and plastic surgery continue to improve with time. Botox injections and Volume fillers continue to be at the forefront of cosmetic rejuvenation given their high safety profile and efficacy. Facial fillers are used to volumize areas of premature hollowness or wrinkling, whereas Botox is used to reduce hyperactive facial muscles around the eyes, forehead, and chin.

Understanding the various attributes of each filler and Botox option can be discussed in detail during your consultation in our Beverly Hills or Santa Monica offices. Rest assured that we will provide you with exceptional attention to detail and professionalism. 
Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Anna Chacon, MD, FAAD · Answer

I can understand why this feels frustrating—especially when it shows up every time you smile. What you’re describing is actually quite common, and it’s not a flaw so much as a combination of muscle movement and natural facial structure.

What’s Causing These “Dents”?
5

Those lines or “dents” from the side of the nose to the cheeks are usually:

Dynamic folds created by smiling muscles (like the zygomaticus muscles)
A result of strong muscle contraction + how your fat pads sit
Sometimes more noticeable if the surrounding areas (like forehead) are relaxed with Botox, making midface movement appear stronger

So in your case, it’s likely a combination of expressive muscles and natural contour, not something abnormal.

Will Botox Help?

In most cases, Botox is not the best solution here.

Why:

The muscles causing your smile are essential for natural expression
Relaxing them too much can lead to an unnatural or flat smile
It may even affect how your upper lip moves

There are very limited, highly precise uses of Botox in this area—but generally, it’s not the first choice for this concern.

What About Filler?
6

Filler can help—but only when used very conservatively and strategically:

Small amounts can soften the transition where the dent forms
Placement is often deeper and closer to structural support areas, not directly in the fold
The goal is blending and support, not adding volume to the cheeks

Done correctly, this can reduce the appearance of those lines without making your face look fuller.

Other Helpful Options
Skin tightening treatments (radiofrequency or ultrasound):
Help improve how the skin and underlying tissue respond to movement
Collagen-stimulating treatments:
Gradually strengthen the area so the “dents” appear less pronounced over time
My Honest Take

From what you’re describing, this is a dynamic, movement-related concern, not something that needs to be “frozen.”

The best approach is usually:

Preserving your natural smile
Softening the transition points with subtle support (not volume)
Avoiding overuse of Botox in the midface

A natural smile with some movement will always look more youthful and authentic than one that’s overly relaxed. The goal is refinement, not erasing expression.

Glenn Murray, MBBS · Answer

Hi Nina, 
This could be a dosing/placement issue of your Botox to your crows feet. Consider having the dose reduced/skip it at your next appointment to see if it makes a difference to the rest of your face.

Warm regards, 
Dr Murray

Large dents starting from the side of my nose over to the apples of my cheeks - will Botox fix this? (Photos)

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