Watch a candid video of yourself mid-laugh and you will likely spot the culprits: folds bracketing the mouth, deeper at the end of the day, shadowed when makeup sinks in. Those laugh lines, or nasolabial folds, have less to do with your sense of humor and more to do with muscle pull, bone loss, and shifting fat pads. Patients often ask for “Botox in the smile lines.” The honest answer is more nuanced. Botox helps in specific ways, but not always where you expect. Getting real about options and outcomes keeps results natural and avoids the frozen look that nobody wants.
What laugh lines actually are
Nasolabial folds form from the side of the nose to the corners of the mouth. They deepen with repetitive facial expressions, but the main driver is volume descent. The midface fat pads slide down with age. The cheekbone loses definition. Skin quality changes from sun exposure, declining collagen, and repetitive motion. Gravity plays a role, although far less than structure and soft tissue changes.
Picture the lower face as a tent. Collagen is the canvas, facial fat pads are the fill, bone is the frame, and muscles are the cords pulling tight. With time, the frame shrinks, the fill thins, the cords tug in predictable directions, and the canvas slackens. Botox, a neuromodulator that relaxes muscle action, can loosen some of those cords. Fillers, bio-stimulatory agents, and energy devices address the frame, fill, and canvas. When we match the tool to the cause, laugh lines soften without making the smile look weak.
Where Botox fits for laugh lines
Botox does one thing very well: it reduces dynamic wrinkling from muscle contraction. If your laugh lines look much deeper when you grin in photos than when your face is neutral, then muscle activity is a significant part of the story. Treating the muscles that contribute to folding near the mouth needs caution, because these muscles also shape speech, smile, and eating. That is why you do not see heavy dosing around the folds themselves.
Instead, we treat contributing zones that indirectly soften the folds by rebalancing muscular pull and expression patterns:
- Small “lip flip” micro-doses along the upper lip border can reduce vertical lip lines and subtly evert the lip, which improves smile show and reduces lipstick bleed without puffiness. DAO (depressor anguli oris) relaxation can reduce downward pull at the corners of the mouth, softening early marionette lines. Done right, the corners lift slightly, making the nasolabial area look less etched. Gummy smile patterns caused by overactive levator muscles can be toned down. When the upper lip doesn’t ride as high, the crease near the nostril doesn’t bunch as much. Bunny lines at the upper nose, which crease when you squint or laugh, can be softened to keep the upper fold from draping sharply into the nasolabial line.
These are measured tweaks, not blanket treatments. We are using Botox for facial expressions that exaggerate folds, not as a filler. When someone markets “Botox for deep laugh lines,” they usually mean a combination plan: a few units placed to rebalance pull, plus filler or other modalities to replace lost support.
What Botox does not do for laugh lines
Many people expect Botox to “fill in” the fold. It will not. If the line is etched when your face is at rest, the issue is volume and skin quality more than muscle. Botox alone will not plump skin, lift sagging cheeks, or replace midface volume. For that, hyaluronic acid fillers near the cheek, calcium hydroxylapatite in strategic planes, or collagen stimulators in select patients do the heavy lifting. Skin laxity and texture respond better to energy-based tightening, microneedling, or biostimulatory techniques than to neuromodulators.
The mouth area is unforgiving. Over-treat with Botox and you risk a flat smile, trouble with P sounds, or sipping through a straw. Practitioners with a light hand and precise mapping avoid these pitfalls. The motto near the mouth is simple: less, then reassess.
A realistic treatment map
Start at the source. I evaluate four zones in every laugh line consult:
Cheeks and midface: If the malar fat pad has dropped, the fold will deepen as the cheek slides forward. Strategic lift with filler in the lateral cheek and midface often softens the fold more naturally than filling the line itself. Patients often look “more like themselves” when support is restored where it was lost, as opposed to stuffing the fold.
Perioral muscles: Hyperactive muscles around the mouth etch vertical lines and tilt the corners downward. Micro-doses of Botox for fine lines around lips, DAO relaxation for marionette lines, and selective treatment for gummy smile patterns often provide a visible improvement without drift.
Skin quality: Thin, sun-worn skin creases easily. Collagen induction with microneedling, fractional lasers, or polynucleotide-rich injectables can improve tensile strength. If wrinkles persist from repetitive motion, a small dose of Botox for wrinkle prevention can reduce the rate of new etching.
Jawline and neck: Platysmal banding and jaw depressor dominance can drag the lower face. Nefertiti-style platysma treatment, when indicated, helps contour the jaw and reduces downward pull. The change is subtle, but the fold often looks lighter once vertical tension decreases.
Dosing and placement basics
While dosing is individualized, most laugh line adjunct treatments use conservative units. DAO relaxation typically ranges from 2 to 5 units per side with onabotulinumtoxinA equivalents, placed just lateral to the marionette line to avoid mouth weakness. Bunny lines often respond to 2 to 4 units per side. Upper lip “flip” dosing runs small, commonly 4 to 8 total units divided across the vermilion border. These are not large doses; the goal is finesse.
If you hear terms like “baby Botox” or “microtox,” they refer to diluted or micro-droplet patterns used to soften fine lines while preserving facial tone. Around the mouth and nose, that concept is especially helpful. Botox for facial symmetry is also relevant here, as most faces pull harder on one side. A few extra micro-units on the dominant side can even out the smile arc.
Timelines: when to expect changes
Neuromodulators do not work the day they are placed. Most patients notice a shift in 3 to 5 days, with full effect around day 10 to 14. If we also used filler near the cheeks or the fold itself, you will see a more immediate softening, sometimes with mild swelling for a day or two. With collagen-stimulating devices or microneedling, improvement tends to step up at 4 to 12 weeks as dermal remodeling unfolds.
For maintenance, three to four months is the typical Botox cycle. Some patients, especially those with lower metabolism or lighter doses, can stretch to four to five months. Filler longevity varies widely by product and placement, from roughly 9 to 18 months for most hyaluronic acids in the cheek, to 6 to 12 months for directly placed nasolabial filler in dynamic zones.
The smile stays sacred
Ask every injector you interview to show before and after photos of smiles, not just neutral expressions. Laugh lines look great at rest in many galleries. botox The true test is a full smile. When Botox for smile enhancement is handled properly, the upper lip shows more of the vermilion without rolling under, the corners of the mouth don’t dive south, and the nasolabial fold softens without flattening the philtrum. Poor technique is obvious when the smile looks labored or asymmetric in motion.
I always test function in the chair. After mapping, we have patients say phrases that load the perioral muscles: “Mississippi,” “puppy pops,” “Fifty five.” If their baseline function already shows weakness, we dial back or shift the plan to filler and skin work instead.
How fillers and Botox team up
Combination therapy is the standard for deep laugh lines. Here is a typical synergy path:
- Restore cheek support first. A modest amount of midface filler can lift shadows off the fold. It often takes less product than people expect when placement is precise. Soften muscle pull next. Botox for facial line smoothing around the nose and mouth in micro-doses keeps new etching at bay and reduces accordion-style bunching when you laugh. Finish with targeted line work. If a crease still catches makeup, a small thread of soft, flexible HA filler directly in the fold can help. This is the most delicate step and often benefits from cannula technique to reduce bruising.
This staged approach creates more durable results with less product. Treating muscles before line filling also reduces the chances of overfilling, since the fold will not be fighting you with every smile.
Special patterns and edge cases
Thin, athletic faces: With low body fat, folds can look sharp even in younger patients. Filler support and gentle biostimulation shine here. Heavy Botox risks a flat expression. Focus on botox to treat facial lines in micro-doses and prioritize volume restoration.
Thicker, sebaceous skin: The fold may look less etched but heavier. DAO relaxation and midface support can help, sometimes alongside radiofrequency tightening. Be cautious directly filling deep folds if the skin is heavy, to avoid a pushed-out look.
Previous overfilling: If the fold has been stuffed repeatedly, the area can look puffy while the rest of the face still sags. Dissolving old filler, restoring cheek support, then reassessing for light fold work is a better plan. Botox for facial tone and small perioral tweaks can keep the area from refolding while you reset the contour.
Dental or bite changes: Missing posterior teeth, bite collapse, or new veneers can shift lower face dynamics. Correcting dental support can make laugh line work more stable. If someone recently changed their bite, I wait a few weeks to see how expression patterns settle before placing Botox.
High-motion professions: Actors, broadcasters, singers, teachers who project a lot, and fitness instructors who cue constantly need special care. The plan leans toward minimal neuromodulation and more on skin and structural support. When we do use Botox for reducing frown lines or bunny lines, we do so conservatively and schedule a two-week review.
What about the rest of the face?
Laugh lines rarely live alone. Most of us also carry brow furrows, horizontal lines across the forehead, or deep crow’s feet from squinting. If your goal is a cohesive refresh, treating companion zones avoids a patchwork look.
Botox to smooth forehead: A few well-placed units can relax deep forehead lines and open the upper face. If brow heaviness is a concern, dosing the frontalis with care and balancing the depressors can give a subtle forehead lift and improve brow shaping.
Crow’s feet and eye area: Botox for eye wrinkles and botox treatment for crow’s feet reduce lateral crinkling. Micro-doses under the eyes need care to avoid smile weakness. For under eye wrinkles or a sunken eye area, skin work or very conservative filler is often a better choice than Botox alone.
Glabellar complex: Botox for reducing frown lines between the brows softens the negative resting expression that often makes laugh lines look starker by contrast. People read faces as a whole. When the brow softens, the lower-face folds seem less severe even if you never touched them.
Chin and jaw: Chin dimpling or chin wrinkles respond well to small doses that calm the mentalis. For heavy lower face pull, botox to lift sagging jowls involves platysma mapping and DAO balancing. Botox for smooth jawline is not a single injection; it is a plan that respects muscle balance.
Neck support: If neck lines and bands contribute, small doses for platysmal bands plus devices or skin treatments can complement the face. Patients sometimes ask for botox injections for neck lines or botox for neck tightening. The best outcomes pair light neuromodulation with collagen remodeling or, in some cases, threads or focused ultrasound. It is appropriate to manage expectations here, since neck skin is stubborn.
Safety, side effects, and sensible cautions
Expect minor redness or pinpoint swelling for 15 to 30 minutes after injections. Small bruises occur in a minority of patients and resolve in a few days. Headaches after glabellar treatment happen occasionally and tend to be short-lived. With perioral dosing, temporary lip heaviness or subtle articulation changes can occur if doses are too high or the patient is very sensitive. When that happens, effects ease as the medication wears off over several weeks. The fix is usually patience, not more injections.
The red flags are unusual but important: significant asymmetry, drooling, inability to smile normally, or difficulty sipping. If any of those appear, your injector should see you quickly. Most cases can be managed with time and supportive care, and sometimes with counterbalancing micro-doses.
Medical history matters. Pregnancy and breastfeeding are exclusions. Neuromuscular disorders, certain antibiotics, and bleeding risks need discussion. If you are planning dental work, a big performance, or travel, schedule injections 2 to 3 weeks before events so you have time to settle and adjust.
Costs and value
Fees vary by region and by injector experience. For perioral and bunny line work, many patients need 8 to 20 total units of neuromodulator per session, often split among DAO, upper lip, and nasal lines. Add cheek support with 1 to 2 syringes of HA filler for structure. While that increases upfront cost, it often reduces the amount of neuromodulator needed long term and creates a more stable contour that ages better.
I often remind patients that the cheapest plan is the one you only do once. Correct placement of necessary support, plus conservative Botox for preventing wrinkles from repeated motion, usually outperforms multiple rounds of small, unfocused fixes.
How skin quality factors into folds
Even with perfect muscle balance and volume, paper-thin skin will crease. This is where a broader rejuvenation mindset helps. You do not need a dozen treatments. A few well-chosen moves can make everything else work better.
- Sun discipline: Daily mineral SPF, ideally SPF 30 to 50, slows collagen loss. It also protects your investment in injectables by preventing pigment and texture changes that highlight folds. At-home actives: Retinoids, vitamin C, and peptides are the workhorses for texture and tone. They will not erase a fold, but they improve how light bounces off the skin so the fold casts a softer shadow. In-office collagen support: Microneedling with or without radiofrequency, non-ablative lasers, or biostimulatory injectables improve skin firmness. Many patients notice that makeup no longer pools in lines after a series. Hydration strategies: Hyaluronic acid-based skin boosters give a temporary plumping effect and improve glide. Think of them as skincare from the inside out, helpful around fine lines near the mouth and cheeks.
Expectations: what “smooth” really means
Clients sometimes bring old photos and ask to erase every fold. That is not the goal. Laugh lines convey life and warmth. The goal is to soften harshness, reduce shadow, and keep the smile lively. If someone tells you they can erase deep laugh lines with Botox alone, keep asking questions. A credible plan might include botox facial contouring tactics, filler for facial volumizing, and skin work for smooth skin texture, sequenced over several visits with check-ins.
When you hear phrases like botox injections for younger skin or botox for youthful glow, translate them into mechanisms: relax overactive muscles, reduce etching, and allow light to reflect evenly. When that balances with structure and skin quality, the face looks rested rather than altered.
A sample plan based on common scenarios
Early thirties, dynamic folds show mainly when smiling: Micro-doses for bunny lines and a small lip flip to address fine lines around lips. No direct fold filler. Reassess at two weeks. If shadow persists, consider light cheek support. Maintenance every 4 months.
Forties, moderate folds at rest with midface descent: Cheek restoration first with 1 to 2 syringes placed laterally and at the apex for lift. DAO softening to reduce downward pull. Optional soft HA thread in the fold only if needed after cheek work. Add skincare for texture. Maintenance: Botox 3 to 4 months, filler 12 to 18 months.
Fifties and beyond, deeper folds, skin thinning, and early jowling: Cheek and pre-jowl support. Conservative platysma mapping for neck pull if indicated. Minimal perioral Botox to protect function. Consider energy-based tightening or microneedling series. Expect staged improvements over 3 to 6 months rather than a single-visit fix.
My take on common myths
Botox will plump my folds: False. Botox relaxes muscle; it does not fill.
Filling the fold is always the solution: Often false. Without cheek support, fold filler can look heavy and artificial. Replace support first.
Botox makes you look frozen: Not if it is planned around expression goals and dosed conservatively. Frozen happens with over-treatment of balancing muscles, especially around the mouth and eyes.
Exercise makes Botox wear off fast: The data are mixed. Very high metabolism and hyperactive muscles can shorten duration, but it is not a universal rule. Plan for a realistic 3 to 4 month interval.
Only one brand works: Several FDA-approved neuromodulators perform similarly when dosed correctly. Minor onset and spread differences exist, but technique matters more than brand name.
A note on adjacent concerns people ask about
Patients curious about laugh lines often ask about other uses, and it helps to understand where Botox helps and where it does not:
- It reduces deep forehead lines and brow furrows by calming frontalis and glabellar muscles, which also can create a mild forehead lift when balanced with brow depressors. It is effective for crow’s feet treatment and under eye wrinkles in careful doses. For under eye puffiness or bags, fillers and surgical options or skin tightening may be more appropriate. It can slim a bulky jawline by relaxing masseters, which also may ease clenching. Jaw slimming takes several sessions and is best for true muscle hypertrophy. It helps with underarm sweating and excessive sweating in palms and soles. That is a different protocol and unrelated to laugh lines, but many patients appreciate the quality-of-life change. It assists with chin wrinkles, upper lip lines, and subtle lip enhancement when paired with filler for lip contouring, as long as speech and smile function are respected.
Choosing the right practitioner
Facial injectables are part anatomy lesson, part artistry. Ask about their approach to botox facial rejuvenation techniques. Look for someone who explains trade-offs plainly and who photographs smiles and animated expressions, not just static faces. Good injectors do not rush. They map, dose conservatively, and bring you back at two weeks for fine-tuning rather than trying to “finish” everything in one session.
I also value practitioners who gracefully say no. If the fold is deep because the cheek has hollowed, botox injections for facial wrinkles near the mouth are the wrong first step. If the skin is fragile, aggressive filler in the fold risks lumps. If your job or hobbies rely on strong articulation, the plan should protect perioral function above all.
The bottom line for laugh lines
For most people, smoothing laugh lines with Botox is not about chasing the fold itself. It is about relaxing overactive contributors, lifting what fell, and improving the skin canvas so light hits evenly. A small, well-placed dose for DAO or bunny lines, plus cheek support and skin quality work, often accomplishes more than heavy injections into the fold. Outcomes should look like you on your best day, animated and at ease, with fewer shadows and softer creases when you smile.
If you want a simple takeaway: use Botox to tune the muscles that overdo the folding, use filler to restore the scaffold that time took away, and support the skin so it behaves. With that sequence, laugh lines soften, smiles stay bright, and maintenance becomes predictable rather than a game of catch-up.