How Safe is Botox when Applied to the Upper Lip for Smoker's Lines?

Considering the fragility and the sensitivity of the skin area, is Botox a recommended option?

Doctor Answers 23

Botox for smoker's lines

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Maybe I am just a chicken but I much prefer filler for smoker's line.  I just think that Botox in that area is too risky.  Even a little over injection can really cause a problem with a crooked smile or even trouble eating or speaking. 

I inject the individual lines with filler and then do just a little filler along the vermillion border.  I really love Prevelle for this area but most patients want a longer lasting filler such as Restylane or Juvederm.  If you have Botox, make sure you go to someone who really, really knows their anatomy.

Seattle Plastic Surgeon
5.0 out of 5 stars 77 reviews

Botox to Lips...

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Depending on the severity of the wrinkles on your lips, Botox is a great option.  Many patients like the result of the mild plumping and the relaxation of pursing the upper lip.  If it is your first time the sensation can be a little strange.  I always encourage my new patients to try it twice before they decide they don't like it.  Reasoning behind this is because the first time is aways 'wierd'.  Some patients may feel a little tingling for a few days, drinking out of a straw or whistling a made much more difficult.  Saying "P's" and "B's" are sometimes hard.  And caution with drinking red wine in a white dress!  =0) 

You have to retrain yourself and keep in mind that your upper lip muscle is relaxing, so dribbling when brushing your teeth is not uncommon until you get used to your 'new mouth'. 

The majority of patients love this technique if done correctly.  If you need more than just Botox to your upper lip, your provider will recommend a filler to help aid in the wrinkles.  This with Botox work beautifully as well!


Good luck.


Dr. Grant Stevens

Grant Stevens, MD
Los Angeles Plastic Surgeon
4.7 out of 5 stars 152 reviews

The best way to treat smoker's lines in the lips

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In my opinion, hyaluronic acid fillers such as Juvederm and Restylane are the treatment of choice for fixing smoker's lines in the lips. Neuromodulators such as Botox, Dysport, or Xeomin can be added, if necessary, to relax particularly strong lip muscles or prolong the results from fillers. 

Mitchell Schwartz, MD
South Burlington Dermatologic Surgeon
4.7 out of 5 stars 12 reviews

Botox in the Lips

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Treating "smokers" lines in the lips is best done with a multi-modality approach.  Botox alone is not likely to give you a satisfactory result.  I suggest as a primary treatment using injectable fillers (Restylane) and then adding very small amounts of Botox as an adjunct.  Treating creases in the lips should be left to someone who has a great deal of skill and experience as you will likely be unsatisfied otherwise.

To be effective, Botox in the lip needs to be done in much smaller amounts and at a much shorter interval than other areas.  For example, you might treat the upper lip with a total of 5 units every 6 weeks.  Fillers on the other hand typically only need to be repeated in this area once per year or maybe less, especially if you maintain your Botox.

When you ask "is it safe", the answer is certainly yes.  There would not be any permanent harm as a result of a poorly done treatment.  You could end up over treated which would certainly be annoying, embarrassing, and challenging, but it would wear off.  It is best to err on the side of under treatment.  Returning after one week for a little more is better than having to wait a month to get control of your lip back!

Louis W. Apostolakis, MD
Austin Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Botox in the upper lip for smoker lines

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It is safe if used conservatively and placed in the right place. You may notice weakening of the lips when sucking on a straw or drinking from a cup and takes a little practice to adjust. Fillers can work well in addition when the lines are deep. In the past collagen was used and worked well but didn't last long. The fillers today may be a little thick and so mixing the Juvederm or Restylane with a small amount of anesthetic makes it more fluid and less thick for the fine lines and works well!


Good luck!!! 

Botox for lips

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If you just want to get rid of wrinkles then Botox may help. Very few units are required. If too much is administered incorrectly, the movement of the lips will be affected and the result will look abnormal and you'll have difficulty moving your lips.

Botox for the upper lip smoker's lines

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Upper lip veritcal creases are caused by multiple factors, different for every patient.  Smoking, chronic sundamage, dentition and age contribute to the lines.  Some lines have been present for so many decades that elimination of the muscle activity below the skin, which had caused the skin to "accordion" and create these lines, won't make the lines go away.  Often these stubborn lines can benefit by using Botox pre resurfacing  as an off-label indication to minimze the active pursing of the lip muscles so there is less creasing of the skin during the healing of the new skin.  The optimal resurfacing may be dermabrasion (sanding), Plasma Portrait resurfacing, Carbon dioxide laser ablative or non-ablative (Fraxel Repair), deep chemical peel, or a series of non-ablative Fraxel Restore lasers (erbium). Fillers also have been used. Some of my patients having Botox as a prelude to fillers or resurfacing did so well that they didn't need the secondary procedures.  The skin is not fragile in this location and Botox can work well. It is as said previously, is an off-label indication.  There is a risk of elongating or flattening the upper lip, asymmetry (lack of balance from side to side, e.g. a crooked smile) and difficulty eating and speaking correctly, singing difficulty and even dribbling. Very few units (1 - 2 units the most) per site injected, and maybe 4 - 6 units for the upper lip total would be used.  The lower lip can be treated similarly. You need to see an experienced physician for this treatment.

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

Filler injections work better!

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There are better options than Botox for smokers lines. I prefer either Laser of filler injections.

Botox for smoker's lines

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Injecting Botox to the upper lip is considered an "off label" use of Botox.  It is very safe if the Botox is delivered in tiny amounts, strategically and symmetrically placed.  If too much Botox is injected, it may become difficult to sip from a straw, whistle, or say certain words that start with the letter "P" or "B", etc.  This is the reason it is best to seek attention from a board-certified dermatologist or plastic surgeon.

Deborah Sarnoff, MD
New York Dermatologic Surgeon

Fillers are best for smoker’s lines

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Generally, smoker’s lines are treated with dermal filler like Restylane or Juvederm not Botox. Smoker’s lines appear due to a loss of volume in the area, so using fillers will restore the volume and decrease the appearance of the unwanted lines. In some cases, Botox can be used as well to treat the lines, but you should see an experienced injector to see what is best for your situation.


Mitchel P. Goldman, MD
San Diego Dermatologic Surgeon
4.9 out of 5 stars 26 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.