Smile lines, also called nasolabial folds, sketch the story of your face. They deepen as collagen thins, fat pads shift, and muscles around the mouth pull on the skin with every grin, smirk, and laugh. If you are here to learn whether botox can erase those lines, the short answer is nuanced. Botox has a role, but not always the starring role. A smart plan starts with understanding why those lines form, where botox actually works, and when another treatment will give you a cleaner, more natural result.
What “smile lines” really are
Most people mean the creases that run from the sides of the nose to the corners of the mouth when they say smile lines. Anatomically, these are the nasolabial folds. There are also radiating fine lines at the outer eyes, often called crow’s feet, which flare with smiling. The vertical lip lines above the upper lip sometimes get lumped in as smile lines too. Each has a different cause and responds to different treatments. That is the crux of realistic expectations.
Nasolabial folds deepen with age due to a combination of midface volume loss, ligament tethering, and skin elasticity changes. These are not primarily muscle-driven wrinkles, so softening them with botox injections often misses the mark. Crow’s feet, on the other hand, are driven by the orbicularis oculi muscle that contracts when we smile, which means botox for crow’s feet can work very well. Vertical lip lines involve muscle overactivity, thinning skin, and repetitive movement around the mouth, which calls for finesse: sometimes baby botox can help, sometimes not.
How botox works, and where it shines
Botox is a neuromodulator. It temporarily relaxes targeted muscles by blocking acetylcholine at the neuromuscular junction. In areas where wrinkles are caused by repeated muscle activity, botox treatment smooths the overlying skin by dialing down that movement. This is why botox for forehead lines, botox for frown lines, and botox for crow’s feet is so popular and effective.
Think of botox cosmetic as movement management. If the wrinkle forms because a muscle keeps folding the skin, botox can soften or erase that fold during the time it is active. If the wrinkle is due to volume loss or skin laxity, a neuromodulator is not the right tool. For smile lines that sit in the middle - a bit of muscle overactivity, a bit of volume change - a combination approach works better.
Anecdotally, after thousands of treatments, I find that patients who do best with botox for smile-related concerns are those who point to crinkling at the outer eyes, “bunny lines” on the nose when they grin, or an overly gummy smile caused by a hyperactive upper lip. Those are muscle problems. Deep folds from the nose to the mouth are structural problems, and they need structural solutions.
Where botox fits for “smile lines”
Let’s break down the smile-adjacent areas where botox may make sense:
- Crow’s feet: Strong candidate. Units of botox needed here typically range from 6 to 12 units per side for an adult, depending on muscle strength and desired softness. Many patients see smoother skin at rest and a softer crinkle when smiling. Natural looking botox in this area relies on dose and placement. Too much creates a flat, expressionless look and can cause under-eye heaviness in the wrong candidate. Bunny lines: Those diagonal lines that appear on the sides of the nose when you smile can be softened with a few units per side. Precise placement matters to avoid lip issues. Botox for bunny lines tends to be subtle and effective when done conservatively. Gummy smile: If excessive gum shows when you smile, small doses of botox at the levator muscles that elevate the upper lip can lower the lip a few millimeters. Gummy smile botox can be transformative in the right face, with a light touch of 2 to 4 units per side. The effect looks natural when tailored and can be a good interim solution before considering dental or surgical options. Lip flip: Micro doses around the upper lip (often 4 to 8 units) can relax the lip muscle, allowing it to roll outward slightly. This increases the visible pink show, not the volume. It does not fill nasolabial folds, but it can change the perception of the smile. You may feel a temporary change in sipping from a straw or pronouncing certain sounds. A lip flip botox approach is subtle by design. Perioral lines: Those tiny vertical “barcode” lines above the lip can be softened with baby botox, but they require a deft hand because too much relaxation here makes the mouth feel weak. When skin is thin, a combination of neuromodulator and energy-based resurfacing or skin boosters is usually better.
In short, botox for smile lines can mean smoothing crow’s feet, taming bunny lines, quieting an overactive upper lip, or adding a subtle lip flip. It does not fill the nasolabial fold itself. That is more often the job of hyaluronic acid fillers, collagen stimulators, or techniques that restore midface support.
Why nasolabial folds resist botox
If you pinch the skin next to your nose and let go, you can see how the fold is tethered. As cheek fat descends with age, the fold becomes more visible because the tissue above deflates and the ligamentous attachments along the fold stay fixed. This is a structural valley, not a muscle crease. Relaxing surrounding muscles with botox cosmetic treatment does not lift or fill that valley. Patients who try botox for nasolabial folds often come back saying nothing changed. They are not wrong. The tool was wrong.
For those particular lines, treatment usually involves dermal fillers placed thoughtfully along the cheek and the fold, sometimes complemented by collagen stimulators or energy-based tightening. In more advanced cases, surgical lifting repositions descended tissues, reducing the depth of the fold by addressing the root cause.
Botox results, timeline, and maintenance
Most patients feel a shift in 2 to 5 days after treatment. Full botox results generally settle by day 10 to 14. If you have a big event, plan your botox appointment two weeks ahead in case a touch up is needed. How long does botox last? Expect about 3 to 4 months for most areas. Some people metabolize it faster, particularly athletes with high cardiovascular output. Others stretch to 5 months with lighter movement goals.
Botox downtime is minimal. You can go back to desk work immediately. There is a small risk of tiny bruises at injection sites, which you can cover with makeup the next day. Botox aftercare instructions usually include staying upright for four hours, skipping strenuous exercise for the day, avoiding heavy rubbing of the area, and limiting alcohol that evening. Patients ask, can you work out after botox? As a rule of thumb, wait a full day for vigorous sweat sessions. Can you drink after botox? Light alcohol is not a disaster, but skipping it that night reduces bruising risk.
How often to get botox depends on your goals. Preventative botox and baby botox have become common for patients in their late 20s and early 30s who want to keep dynamic lines from etching in. Mature patients often schedule botox maintenance three or four times a year. A personalized botox plan is more reliable than a rigid schedule. When movement returns in a way that bothers you, it is time.
Safety, side effects, and what good technique looks like
Botox cosmetic has an extensive safety record when used properly. The most common side effects are temporary: mild soreness, redness, or a small bruise. Headache can occur for a day or two. Rare effects come from product diffusing to nearby muscles, for example, a heavy brow after aggressive forehead dosing, or a temporary eyelid droop when glabellar injections migrate. These are technique issues more than product issues. They fade as the botox wears off.
Is botox safe? In trained hands, yes. Medical history matters. If you are pregnant, breastfeeding, have active infections at the injection site, certain neuromuscular disorders, or allergies to the formulation components, you should not receive botox. Disclose medications that thin blood, including supplements like fish oil and ginkgo.
Natural looking botox comes from customization, not a cookie cutter pattern. Units of botox needed are not a one-size number. A patient with a small frame and delicate muscles might need half the dose a larger patient requires, even for the same area. Dysport vs botox or Xeomin vs botox often comes up. All are botulinum toxin type A, with differences in proteins and diffusion. An experienced injector chooses based on technique, area, and how you responded in the past. It is fine to try another brand if you felt your botox wore off too quickly or spread more than you liked.
What botox costs, and how to think about value
Pricing varies widely by geography, injector expertise, and practice structure. Some clinics price per unit, others per area. Botox pricing per unit often ranges from modest to premium, and botox cost per area for crow’s feet, glabella, or forehead is sometimes bundled. Affordable botox exists, but deals that seem too good to be true usually are. Beware of deep botox deals that push high-volume, low-consultation models. You want an individualized assessment, high-quality product, and reliable follow-up.
When comparing quotes, ask how many units are included, whether a botox touch up is built into the price, and what follow-up policy looks like if you need a minor adjustment. The best botox clinic does not necessarily market the cheapest price. Look at botox patient reviews, before and after photos, and how the injector explains trade-offs.
Alternatives to botox for smile lines
If your primary concern is the nasolabial fold, consider the following options, often combined for best results.
- Hyaluronic acid fillers: Strategic filler can soften the shadow without puffiness when placed carefully along the midface and fold. A conservative approach brightens the area. Overfilling the fold itself can look unnatural when smiling. I prefer to restore volume upstream in the cheek before touching the fold. Longevity ranges from 9 to 18 months depending on the product and area. Collagen stimulators: Products like poly-L-lactic acid or calcium hydroxylapatite can improve skin thickness and support over several sessions. They build a scaffold over months, making them a slower but very natural route. Great for patients who prefer global subtlety. Energy-based devices: Radiofrequency microneedling or focused ultrasound can tighten skin and stimulate collagen, which softens the appearance of folds by improving skin quality. Expect steady gains with a series, not a miracle in one visit. Skin boosters and biostimulators: Microdroplet hyaluronic acid or polynucleotides can enhance hydration and elasticity, making etched fine lines around the mouth less noticeable. They do not replace the need for structural support but add polish. Surgical options: In advanced cases, a lower face or midface lift repositions descended tissues and sharpens the fold by changing the architecture. A conservative surgical plan often yields the most natural outcome when folds are deep and cheeks have flattened.
Notice what is missing: botox for sagging skin or the fold itself. Neuromodulators cannot lift tissue. They can only relax muscle.
Combination strategies that work in real life
A mid-30s patient with fine smile-related crinkling at the outer eyes, early nasolabial folds, and a slightly gummy smile might see the best result with botox for crow’s feet, a tiny dose to reduce gum show, and light cheek filler to restore upper cheek projection. The folds look softer because the cheek casts less of a shadow, and the smile looks more balanced.
A 50-something patient with moderate folds, etched barcode lines, and strong orbicularis activity might benefit from a staged plan: collagen stimulator sessions to rebuild support, fractional resurfacing around the mouth, then refined filler in the midface, and conservative botox to the crow’s feet. This sequence respects the hierarchy: structure first, skin second, movement last.
For a first time botox patient who is nervous about looking frozen, baby botox can be a smart entry. Lower doses spread across the forehead, glabella, and crow’s feet create subtle botox results. You can always add at the two-week check if you want more smoothing. A personalized botox plan keeps you in control.
Setting expectations without overpromising
Botox for wrinkles is powerful in the right places. It reduces dynamic lines when muscles contract. It does not fill, lift, or thicken skin. Knowing that difference is the key to liking your results. If your goal is fewer crinkles when you smile, botox for crow’s feet will likely please you. If your goal is a shallower groove next to your nose, you are looking at fillers or structural work. The temptation to try everything at once is real, but faces respond best to measured steps.
When does botox start working? Early changes in a few days, peak at two weeks. When does botox wear off? Around three or four months for most, sooner or later depending on metabolism and dose. Botox recovery time is essentially a day of caution. What not to do after botox: do not rub vigorously, do not lie down flat for a few hours, do not head to hot yoga that night, and do not book a facial the same day. If you do none of these, you will likely be fine, but reducing risk is smarter than testing luck.
Special considerations around the mouth
Working near the mouth magnifies small mistakes. Over-relaxing the orbicularis oris can affect speech and sipping. If you are considering botox for chin dimpling or pebbled chin, light dosing can smooth the skin texture without making the lower lip feel heavy. Masseter botox or jawline botox reshapes the lower face by slimming the chewing muscles, but it will not change nasolabial folds. TMJ botox treatment can relieve jaw clenching and botox for teeth grinding can protect enamel, though these are therapeutic botox indications and dosing differs.
If you struggle with migraines, migraines botox treatment follows a standardized protocol across head and neck points. It has nothing to do with softening smile lines, but patients often pair therapeutic botox with cosmetic treatments during a single visit to save time. The same applies for hyperhidrosis botox treatment for excessive sweating, whether underarms or palms. Combining appointments is efficient when your injector is trained across indications.
Finding the right injector and asking the right questions
The best botox doctor listens first. A thorough botox consultation should include a facial analysis in motion and at rest, a review of your medical history, and a discussion of what bothers you and what does not. I often ask patients to show me photos they like of themselves, and photos they do not. That reveals your aesthetic preferences. If you say you never want your eyebrows to stop lifting when you talk, it shapes how I dose Allure Medical botox the forehead. If you crave a non surgical brow lift, a tiny eyebrow lift botox trick with careful lateral placement might help, but only if your brow position and eyelid skin can support it.
Helpful botox consultation questions to ask:
- Which areas are muscle-driven versus volume-driven in my case, and how will that change the plan? How many units do you expect to use, and what is the cost for those units? What is your approach if I need a small touch up at two weeks? How soon will I see changes, and what will it look like at rest versus in motion? If we are treating smile-related concerns, where do fillers or skin treatments fit, if at all?
If a clinic pushes same day botox without a conversation or tries to sell a botox package without examining your movement, keep looking. A customized botox treatment will always beat a one-size-fits-all bundle. Memberships can be a good value if they include measured dosing, follow-up, and a plan that adapts as you age.
What a typical appointment feels like
A botox appointment for smile-related areas usually takes 15 to 30 minutes. Photos document your baseline. You will frown, smile, and squint on command. After cleaning the skin, the injector places microdroplets with a fine needle. Most patients rate the discomfort a 2 to 3 out of 10. You may notice tiny raised blebs that settle in minutes. Makeup can go on the next day. If bruising occurs, it is often a small freckle-sized spot.
You might feel slightly heavy at the outer eyes for a few days as the botox begins to work. That sensation fades. The two-week mark is the time to assess. If you want a touch more softening or a small tweak to balance asymmetries, that is when it is done. Consistency with the same injector helps, because your map and dosing history refine over time.
Edge cases and when to pause
There are times to delay. If you have an important speaking event within a few days, do not experiment with perioral botox for the first time, because subtle lip weakness can make you feel off. If you are planning significant dental work, schedule botox after, not before, since mouth manipulation can move product in the early hours. If you have a history of eyelid ptosis after brow injections, your injector should alter the forehead plan, or you might consider fewer areas at once.
For those with very thin, crepey skin, botox alone will not solve etched lines. Think in layers: improve skin quality with retinoids, SPF, and perhaps energy devices first, then add neuromodulators, then layer fillers if needed. You do not paint a house before fixing the siding.
A brief note on men and movement
Botox for men, sometimes called brotox, follows the same principles with a few adjustments. Male foreheads have stronger muscle pull and lower resting brows. Aggressive forehead botox risks a heavy look. Dosing often needs to be higher per unit, but placement must respect male anatomy to maintain a natural, masculine brow. For smile-related issues, crow’s feet tend to require more units in men. The goal remains the same: less crinkle, not no expression.
Realistic before and after expectations
You will see smoother crow’s feet and softer bunny lines in your botox before and after photos if those were treated. Your nasolabial folds will look unchanged unless you also addressed volume or skin quality. When patients understand this, satisfaction stays high. When patients expect botox to do the job of fillers or a lift, disappointment follows. Set the target correctly and you will hit it.
Putting it all together: a practical path
Start with a consultation focused on movement map and structural support. If your main complaint is smile-related crinkling at the eyes or gum show, botox is a strong first move. If your main complaint is nasolabial depth, talk fillers, collagen stimulators, or energy devices, and consider botox for crow’s feet as a complement, not a solution. Plan at least two weeks before events. Expect maintenance every three or four months if you like the effect. Keep doses conservative until you learn how your face responds. Ask for subtle botox results if you are new to this, and build gradually.
The best age to start botox depends on your lines and your goals, not the calendar. Some benefit from preventative botox in their late 20s when lines begin to linger after expression. Others wait until lines are visible at rest and still achieve a refreshed look. Either way, choose an injector who prioritizes structure and proportion over chasing every line with a syringe. That restraint is what keeps a face expressive and human.
When you think of botox for smile lines, picture a toolkit, not a magic eraser. Use neuromodulators to manage movement where movement causes lines. Use fillers and biostimulators to restore support where volume and collagen have faded. Use energy to tighten and refine the skin. The art lies in sequencing and dose, and in honoring the way you naturally smile.