Botox for smoker wrinkles. Is there a better place to inject than the vermillion border? (Photo)

Question

Hello, I have smoker wrinkles. I have tried Botox/Restylane Silk. The problem with the Botox is that it is injected into my vermilion border. This only prevents me from pursing and creating wrinkles that would form directly above the vermilion (lipstick bleed lines). But my lines are closer to my nostrils, like whiskers. Even after the Botox I can still purse/pout lips and create dynamic lines. Is there a better place to inject to get desired preventative effect. They are getting much worse.

Harold J. Kaplan, MD · Answer

Hello Celebrated.  Yes Botox can be injected at the vermillion border and above it to soften the lines.  We will offer this procedure (and dermal fillers) for those that have smoker's lines, but our preference is to get rid of them completely with a deep resurfacing.

Jonathan Kulbersh, MD · Answer

Hello — thank you for providing these helpful photos along with your question. To answer your question about Botox injection areas, you can inject the treatment slightly higher. However, smoker’s lines are typically best treated with dermal fillers, such as Juvederm or Restylane. It looks like you’ve already tried Restylane Silk. I would recommend speaking with a board-certified facial plastic surgeon about potentially combining that treatment with laser resurfacing, chemical peels, microneedling, and other nonsurgical remedies for static wrinkles.

Neal G. Moores, MD · Answer

The injections could be anywhere on the lip. The key thing though is not to inject too much. With the mouth its important to appreciate that you have to be able to keep your mouth closed to chew, and talk etc. Your injector is likely keeping to the vermillion to avoid over paralyzing the muscle, which is good. If you waited until the current botox wore off, it would be ok in the future to inject elsewhere, so long as the dose was the same/similar. Also, the dose may need to be less, as the botox will probably come in contact with more functional muscle fibers, but this is important to discuss with your injector.
*Note without an in person exam and interview, this answer refers only to generalities and cannot be considered medical treatment or individual medical advice.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  You can have the Botox injected higher into the paler skin of the upper lip to seek further improvement but this is an area whereby multimodal treatment with fillers, peels, micro needling, etc, is a necessity.

Jason Emer, MD · Answer

these lines need peels, lasers and at home dermarolling. fillers can help but only help one part. you need collagen remodeling.

at home peels like cosmelan, enlighten and aerify along with dermarolling (EmerageSkin roller with anteage AERIFY MD ampules weekly, see link) should be started now to prevent further aging.

For facial rejuvenation,  I would suggest a combination approach of 
1) skin care with products and PRP/microneedling
2) PDT light therapy few times a month with growth factors
3) laser treatments like clear and brilliant regularly and a few times a year Fraxel/halo Viva, Co2/Erbium
4) Sculptra injections a few times a year for collagen production with fillers like juvederm/restylane/belotero/radiesse/bellafill
5) thermage/ultherapy for yearly skin tightening with or without PDO or cone based instalift threads for lifting
6) botox every 2-3 months to stop movement lines and prevent lines at rest
7) deep microneedling RF like Fractora/morpheus8 for tightening of the skin
8) Vascular laser like vbeam/excel V or BBL forever young treatment every quarter (3-4 months)

Best, Dr. Emer.

Michael I. Echavez, MD · Answer

Botox can be injected above the vermillion border of the lip when treating smoker's lines.  You could try having it injected higher than you currently are to see if that leads to improvement.

Camille Cash, MD · Answer

If Botox isn't working to get the desired effect on smokers lines you may want to work on skin texture.  You can consider treatments including Morpheus8, peels, and lasers.  I've included a video I hope you find helpful.

Dmitriy Schwarzburg, MD · Answer

Anywhere between base of the nose and vermillion border can be injected and a combination of fillers and other tools can be utilized. Consult a board certified physician for best results.

Onir Spiegel, DDS, PhD · Answer

Hyaluronic acid fillers like Juvederm, Restylane and Versa are better for smokers lines than botulinum products like Botox, Dysport, Xeomin, Juveau!

Emil Shakov, MD · Answer

You could try dermal fillers instead or PDO monothreads for a more lasting result. Microneedling with RF will also improve this area

Botox for smoker wrinkles. Is there a better place to inject than the vermillion border? (Photo)

Answers (11)

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