You’re not imagining it — the lines around your mouth are different from the ones on your forehead. They show up earlier, they deepen faster, and creams don’t touch them. That’s because they’re caused by two separate problems happening at once: muscle movement that folds the skin thousands of times a day, and collagen loss that means the skin stops bouncing back.
The fix isn’t one treatment — it’s knowing which problem you’re solving.
Dr. Joseph H. Chang at Modern Aesthetic Institute in Bakersfield has been treating perioral lines for 25+ years. He’s a Top 20 national Dysport injector and a UCLA-trained oculoplastic surgeon — which means he brings surgical-level precision to this particularly unforgiving area of the face. Here’s his straight-line breakdown of what works, what doesn’t, and how to pick.
The Three Types — and Why It Matters
Not all lines around the mouth are the same. Picking the right treatment starts with identifying which type you have.
Smile lines (nasolabial folds)
The creases that run from the sides of your nose down to the corners of your mouth. They deepen when you smile — hence the name. In younger skin, they disappear at rest. As collagen depletes, they stay visible even when your face is relaxed.
Smoker’s lines (perioral lines)
The fine vertical lines that radiate directly from the lip border. They have nothing to do with smoking — they form from the constant pursing motion of speaking, drinking, and making expressions. They’re the ones that make lipstick bleed.
Marionette lines
The lines that run downward from the corners of your mouth toward the chin. They create a downturned, heavy expression even when you’re not frowning. Often the result of volume loss in the lower face pulling skin downward.
Each type responds to a different treatment approach.
The Treatments — Matched to the Problem
Botox & the Lip Flip (best for smoker’s lines + early perioral lines)
Botox relaxes the orbicularis oris — the circular muscle that surrounds your mouth and contracts every time you speak, sip, or purse your lips. Fewer contractions means less repetitive folding, which means shallower lines over time.
The lip flip is a specific Botox technique: a small amount is placed just above the upper lip, causing the muscle to relax outward. The lip subtly rolls up, softening vertical lines at the border and creating a slightly more defined shape — without adding any volume.
This is often the right starting point for patients with fine lines above the lip. It’s quick, inexpensive, and completely reversible.
What Botox can’t do: it won’t fill lines that are already etched in at rest. For those, you need filler.
Botox around the mouth lasts 2–3 months (the muscle is very active). Many patients find the interval stretches over time.
Dermal Filler (best for smile lines, marionette lines, static lines)
Hyaluronic acid filler placed into or beneath a line pushes the depressed skin upward, smoothing it from the inside. Think of it like filling a crack rather than painting over it.
Smile lines and marionette lines typically respond well to filler placed along the fold and into the lateral cheek to restore the support structure above. The goal isn’t to eliminate the line entirely — a completely flat nasolabial fold looks unnatural — but to soften it so it no longer reads as an aging marker.
For smoker’s lines, filler is used in very small amounts along individual creases. This is one of the most technique-sensitive areas on the face. Too much filler creates visible lumps, migration, or that “lip shelf” look. Dr. Chang uses a conservative amount with a fine needle or cannula — enough to smooth, not enough to inflate.
Filler in this area lasts 6–9 months. Combined with Botox, it lasts longer because there’s less muscle activity working against it.
Combination (best for established lines with both dynamic and static components)
Most patients over 40 benefit from both. Botox prevents the muscle movement that keeps recreating the lines; filler smooths what’s already there. Dr. Chang typically spaces them two weeks apart — Botox first, then filler once the muscle has settled — so he can assess exactly how much filler is needed rather than guessing.
Quick Self-Assessment
| What you’re seeing | Likely best fit |
|---|---|
| Fine lines above lip, mainly when moving | Botox / lip flip |
| Lipstick bleeding into vertical lines | Botox + small amount of filler |
| Deep smile lines visible at rest | Filler (nasolabial) |
| Downturned corners of mouth | Filler (marionette) + DAO Botox |
| All of the above | Combination — Dr. Chang will assess |
Why This Area Demands an Experienced Injector
The mouth area is unforgiving. The skin is thin, the muscle is constantly active, and there are no good hiding spots for mistakes.
Too much Botox around the mouth and you lose the ability to pronounce certain sounds or drink from a straw. Too much filler and you get visible lumps or product migration. The difference between a result that looks refreshed and one that looks “done” is almost entirely technique.
Dr. Chang’s background as an oculoplastic surgeon — where millimeter-level precision is a baseline requirement — translates directly into his injectable work. His Top 20 national ranking by Dysport volume reflects consistency across thousands of patients, not a single great result.
His philosophy: use less than you think you need. A 70% improvement that looks completely natural is better than 100% correction that draws attention.
FAQ
Can Botox fix the lines around my mouth?
Botox helps most with lines that appear when your mouth is moving — perioral lines (smoker’s lines) and early smile lines. For lines that are visible even at rest, filler is needed to fill the crease from underneath. Many patients use both.
What is a lip flip, and is it the same as lip filler?
No — they’re different. A lip flip uses a small amount of Botox above the upper lip to relax the muscle and roll the lip slightly outward, which softens vertical lines and creates subtle definition. No volume is added. Lip filler adds volume to the lip itself. A lip flip is faster, less expensive, and completely reversible.
How long do results last around the mouth?
Botox lasts 2–3 months in this area due to constant muscle activity. Filler lasts 6–9 months. Most patients do Botox every 3 months and filler every 6–9 months to maintain consistent smoothing.
Will filler make my lips look bigger?
Not if the goal is treating lines around the mouth. Filler placed into smile lines, marionette lines, or individual perioral creases smooths the skin — it doesn’t add volume to the lips. If you want lip volume, that’s a separate conversation.
I’ve never smoked. Why do I have smoker’s lines?
The name is misleading. Perioral lines develop from the constant pursing motion of speaking, drinking, and making facial expressions — habits every person has regardless of smoking history. Sun exposure and collagen loss accelerate them. Non-smokers develop them all the time.
What’s the difference between smile lines and marionette lines?
Smile lines (nasolabial folds) run from the nose to the corners of the mouth. Marionette lines run downward from the corners of the mouth toward the chin. Both are treated with filler, but the placement and technique are different. Some patients have both.
Is treatment around the mouth painful?
More so than the forehead — the perioral area is more sensitive. Topical numbing is available, and fillers contain lidocaine that kicks in as the product is placed. Most patients describe it as tolerable. Expect minor swelling for 3–5 days after filler; Botox has virtually no downtime.
Ready to Book?
Dr. Chang offers in-person consultations at Modern Aesthetic Institute in Bakersfield. He’ll assess your specific lines, tell you exactly which treatment fits, and show you before-and-after photos from patients with similar concerns.
Call: 661.535.0149
Book online: modernaesthetic.institute/contact-us/
4000 Empire Dr., Suite 300, Bakersfield, CA 93309