Question: My coworker recently suggested a Botox treatment to reduce the wrinkles around my mouth. I have heard this injectable is derived from the pathogen that causes botulism. Can Botox have negative side effects?

Answer: Well, your friend is correct that Botox is a derivative of the chemical that causes botulism but, used under very controlled circumstances, can do a wonderful job of improving lines on the face. The specific lines that you mentioned, which are the lines around the mouth, are much more difficult to treat with Botox since we do not want to overly relax the muscle around our mouth for fear that we would then cause difficulties with our ability to drink, eat, and speak and this obviously would not be warranted for a cosmetic improvement in wrinkles. I, therefore, occasionally use Botox in and around the mouth but much more frequently either recommend filler injections such as Juvederm and Restylane or will recommend a laser resurfacing, which can provide an excellent improvement in wrinkles around the mouth.

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Question: I am a 56-year-old female who had a midface lift about 7 months ago. I have noticed some of my skin still sags around my nose. Is there another alternative to help fix this problem?

Answer: I am personally not a big fan of using midface lifts alone to try and improve the smile line from the nose down towards the corner of the mouth. My personal experience is that a deep plane facelift would do a much better job of effacing this fold than a standard midface lift would. With that being said, an easy remedy for your problem is simply to fill this area with some Juvederm or Restylane or even consider Radiesse or Sculptra as well. Another possibility is to consider cheek implants if you have a significant degree of volume loss in that area.

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