You’ve seen the photos. Those crisp, high-definition "after" shots where a person’s smile looks airbrushed, the tiny vertical lines have vanished, and the corners of the mouth no longer downturn into a permanent frown. It looks like magic. But honestly, botox around the mouth before and after results are rarely just about looking "younger"—it’s a high-stakes game of millimeters. One tiny slip and you can’t use a straw for three months.
I’ve spent years watching the aesthetic industry evolve from the "frozen face" era of the early 2000s to the current obsession with "micro-dosing" neurotoxins. People are obsessed with the mouth area because it’s the most mobile part of the face. We talk. We eat. We kiss. We grimace. When you put a paralytic like Botox (onabotulinumtoxinA) or its cousins Dysport and Xeomin into this zone, you aren't just smoothing skin. You’re rewiring how you communicate.
The Reality of the "Lip Flip" and Smoker's Lines
Most people looking for botox around the mouth before and after examples are actually looking for two specific things: the "Lip Flip" or the erasure of perioral lines (those pesky vertical "smoker's lines" that appear even if you’ve never touched a cigarette in your life).
The Lip Flip is a bit of a misnomer. It doesn’t actually add volume like a dermal filler (Juvéderm or Restylane) would. Instead, a provider injects about 2 to 4 units of Botox into the orbicularis oris muscle, right at the Cupid’s bow and the corners of the upper lip. This relaxes the muscle that normally curls your lip under when you smile. The result? More of your pink lip tissue stays visible. It looks poutier. It looks natural.
But here is the catch.
If your injector overdoes it, your upper lip becomes a dead weight. I’ve seen patients who can’t pronounce their "P" or "B" sounds correctly for weeks. You try to say "Peter Piper," and it sounds like you’ve had a local anesthetic at the dentist. This is why the "before and after" is so tricky—a photo doesn't show you the struggle of drinking a latte through a lid.
Why those vertical lines happen
Perioral lines are usually the result of a lifetime of muscle contraction. Every time you purse your lips, you’re folding the skin. Over time, as collagen and elastin degrade (thanks, birthdays and UV rays), those folds become permanent fixtures. Botox helps by softening that "pursed" action.
Realistically, if you look at a botox around the mouth before and after comparison for deep lines, you’ll notice they rarely disappear 100%. If a clinic shows you a photo where deep, etched-in lines are totally gone with just Botox, they are probably lying or using a heavy filter. Usually, you need a combination of Botox to stop the movement and a very thin filler or laser resurfacing to fix the "etching" that’s already there.
The Downturned Smile: Fixing the "Sad" Look
As we age, the Depressor Anguli Oris (DAO) muscle—the one that pulls the corners of your mouth down—gets a bit too enthusiastic. It creates that "marionette" shadow that makes you look grumpy when you’re actually perfectly happy.
Injecting the DAO is one of the most satisfying uses of Botox.
When you relax that downward pull, the corners of the mouth return to a neutral position. It’s subtle. It’s not a facelift. But in the botox around the mouth before and after context, this is often the change that makes friends say, "You look rested," without being able to point out exactly why.
Dr. Mauricio de Maio, a world-renowned plastic surgeon, often discusses the "MD Codes," which involve treating the DAO to change the emotional attribute of the face. It’s less about wrinkles and more about the "message" your face sends to the world.
Gummy Smiles and the Paradox of Movement
Some people hate how much of their gums show when they laugh. Botox is a literal game-changer here. By targeting the levator labii superioris alaeque nasi (try saying that five times fast), an injector can drop the upper lip just enough to cover the gums.
The "before" is usually a wide, toothy grin. The "after" is a more controlled, "sophisticated" smile.
However, you have to be careful.
If the injection is asymmetrical, your smile will be crooked. This isn't like a bad haircut; you can't just wear a hat. You have to wait for the toxin to wear off, which takes 3 to 4 months. This is why finding an injector who understands anatomy—not just someone who took a weekend course—is the difference between a great result and a "What happened to your face?" result.
The Cost, the Pain, and the Longevity
Let's talk brass tacks.
- Units: You don’t need much. We’re talking 2 to 10 units total.
- Price: Depending on where you live (NYC vs. a small town in Ohio), you might pay anywhere from $50 to $200 for this specific area.
- Pain: It’s a pinch. The area around the lips is spicy, though. It’s full of nerve endings. Expect your eyes to water.
- Duration: Here’s the bummer. Botox around the mouth doesn't last as long as it does in the forehead. Because you move your mouth constantly, the muscle clears the toxin faster. Expect results to fade in about 8 to 10 weeks.
Critical Side Effects Nobody Discusses on Instagram
Instagram is a lie. Okay, maybe not a total lie, but it’s a curated version of the truth. When researching botox around the mouth before and after, you need to know the potential "fails" that don't make the grid.
- The "Stiff Lip": Your lip feels heavy. You can't quite tuck it in when you're eating soup.
- Drooling: It sounds dramatic, but if the DAO or orbicularis is over-relaxed, you might lose a bit of "seal" on your mouth.
- Asymmetry: One side of your smile might lift higher than the other.
- The "No-Smile" Smile: If the levator muscles are hit too hard, you lose the ability to show your upper teeth when you laugh. You end up with what I call the "Mona Lisa on Benadryl" look.
Dr. Shereene Idriss, a well-known dermatologist in NYC, often speaks about the importance of "less is more" in the lower face. She’s right. You can always add more, but you can’t take it out.
What to Do Before Your Appointment
Don't just walk into a medspa and say "fix this." Be specific.
First, check for bruising triggers. Stop taking fish oil, aspirin, or vitamin E about a week before. The mouth area is vascular; you will bruise easily. If you have a history of cold sores, Botox can sometimes trigger a flare-up. Ask your doctor for a prophylactic dose of Valtrex before you go.
Second, manage your expectations. If you have very deep, structural folds (marionette lines), Botox alone is going to disappoint you. You’re likely looking at a "liquid facelift" approach involving fillers like Voluma or even structural treatments like Ultherapy to lift the skin from the cheek area.
How to vet an injector
- Ask how many Lip Flips they do a week.
- Ask what happens if your smile goes crooked. (A good injector has a plan).
- Look at their botox around the mouth before and after gallery, specifically looking for movement photos or videos, not just still shots.
The Verdict on the Lower Face
Is it worth it?
For the right candidate, absolutely. If you’re bothered by a "gummy" smile or those tiny lines that make your lipstick bleed, Botox is a miracle. It’s cheaper than filler and less invasive than a lip lift surgery.
But it’s high-maintenance.
You’ll be back in that chair four times a year. If you’re okay with the upkeep and the "learning curve" of how to move your mouth post-injection, go for it. If the idea of not being able to whistle or use a straw properly for a few weeks sounds like a nightmare, stick to a good topical retinol and a thick lip mask.
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Actionable Next Steps
- Identify your primary concern: Is it the lines, the "sad" corners, or the gum show? This determines exactly where the needles go.
- Consultation first: Book a standalone consult. If they try to inject you 5 minutes after meeting you without a full facial analysis, run.
- The "Sip" Test: Post-procedure, wait 4 days and then try to drink through a straw. This is your baseline for how the muscle relaxation is affecting your motor skills.
- Document your own "Before and After": Take photos in natural light—one with a resting face, one with a full "cheese" smile, and one with a puckered "kiss" face. This is the only way to truly track if your $150 was well spent.
The goal isn't to look like a different person. It’s just to look like you, but perhaps a version of you that didn't spend the last decade stressing out or drinking through straws. Just remember: when it comes to the mouth, less is almost always better. Keep the movement; lose the tension.