What’s the Best Way to Treat Smile Lines—Botox or Filler?

This is a commonly asked question our physician injectors often get at MD Skin Lab: “Can I treat my smile lines with botox?”

While it’s easy to assume Botox can fix any wrinkle or line, the truth is—botox isn’t the right solution for smile lines. In fact, our physician injectors typically don’t use it in that area.

Smile lines (also known as nasolabial folds) form due to a combination of factors, including collagen loss, skin laxity, and volume depletion, not overactive muscles. Since botox is designed to relax muscle movement, it’s not the most effective approach for smoothing out these deeper creases.

Instead, our physician injectors recommend treatments such as hyaluronic acid (HA) fillers, Radiesse, and microneedling are far more effective options, especially when customized to the individual’s unique skin quality and facial anatomy.

Let’s break down what causes smile lines, why botox isn’t recommended, and the safest, most effective ways to treat them for natural, long-lasting results – all from doctors at our Toronto medical clinic. 

What Are Smile Lines?

Smile lines—or nasolabial folds—are the natural creases that run from the sides of your nose down to the corners of your mouth. These folds deepen over time due to repeated facial movement, loss of skin elasticity, and volume depletion in the cheeks.

Everyone has smile lines to some degree. However, as collagen levels decline with age and the skin loses its firmness, these lines can become more pronounced, even when the face is at rest.

It’s also important to note that some patients refer to smile lines as lines around the mouth in general. Depending on whether you're dealing with folds, etched-in lines, or loss of support in the midface, your treatment approach may vary.

Why Botox Isn’t Typically Used for Smile Lines

Botox (botulinum toxin) works by temporarily relaxing the muscles responsible for dynamic wrinkles—those that form from facial expressions like squinting, frowning, or smiling. This is why botox is so effective for areas like:

• Forehead lines

• Frown lines (glabellar lines)

• Crow’s feet (around the eyes)

• Bunny lines (on the nose)

But smile lines are different. These folds aren’t primarily caused by muscle activity—they’re the result of structural changes in the skin and facial fat pads.

Using botox in the nasolabial area can lead to unwanted outcomes, such as affecting your ability to smile or make natural facial expressions. For this reason, our physician injectors don’t consider botox to be an effective treatment for smile lines. 

What Does Work for Smile Lines?

At MD Skin Lab, we take a customized, patient-centred approach to treating smile lines. In most cases, the most effective treatment involves dermal fillers—either hyaluronic acid-based or biostimulators, such as Radiesse. In some instances, we may also recommend microneedling or skin-tightening therapies to improve skin quality in the area.

Let’s explore each option at our Toronto medical clinic. 

Option #1: Hyaluronic Acid Fillers for Smile Lines

Hyaluronic acid (HA) is a naturally occurring substance in the body that helps retain moisture and volume. HA fillers are soft, flexible, and well-suited for adding volume and smoothing moderate nasolabial folds.

These fillers work by gently lifting the skin and restoring lost structure, resulting in a smoother and more refreshed appearance. They also integrate well with the surrounding tissue, offering natural-looking results.

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Benefits of HA fillers:

• Immediate improvement in volume and contour

• Natural look and feel

• Reversible if needed

• Results typically last 6 to 12+ months

• Minimal downtime

You can book your Dermal Fillers appointment here. 

Option #2: Radiesse®: A Biostimulator for Deeper Folds

For patients with deeper or more established smile lines, Radiesse can be an excellent choice. Unlike HA fillers, Radiesse is made of calcium hydroxylapatite (CaHA) microspheres suspended in a gel carrier. It offers immediate volume and also works beneath the skin to stimulate your body’s own collagen production.

This dual-action approach ensures that results continue to improve over time, making it an excellent option for patients seeking both immediate and long-term benefits.

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Benefits of Radiesse:

• Strong lifting capability for deeper folds

• Long-lasting results (12–18 months)

• Supports collagen regeneration

• Ideal for patients seeking firmer, more youthful skin

You can book your Radiesse® appointment here.

Option #3: Microneedling for Etched-In Smile Lines

When smile lines are etched into the skin—visible even without expression—filler alone may not fully resolve the issue. That’s where microneedling comes in.

Microneedling is a procedure that utilizes SkinPen, a specialized device with tiny, sterile needles to create controlled micro-injuries in the skin, triggering a natural healing response. Over time, this stimulates the production of new collagen and elastin, helping to smooth and tighten the skin. The 

At MD Skin Lab, we often combine microneedling with:

• PRP (Platelet-Rich Plasma) for accelerated healing and regeneration

• Exosomes for cellular-level repair and enhanced collagen synthesis

These regenerative techniques help soften lines and improve skin quality, particularly in patients seeking to target both texture and tone.

Benefits of Microneedling:

• Stimulates natural collagen and elastin production

• Softens etched-in lines and improves skin texture

• Enhances tone, firmness, and overall skin quality

• Can be combined with PRP or exosomes for advanced skin regeneration

• Minimal downtime with long-term skin rejuvenation effects

You can book your Microneedling appointment here.

Option 4: Radiofrequency Microneedling with Morpheus8 for Tighter Skin

When smile lines are paired with skin laxity and overall loss of firmness, Morpheus8 provides an advanced solution that delivers results beyond the surface level.

Morpheus8 combines microneedling with radiofrequency (RF) energy, delivering controlled heat deep into the dermis. This stimulates collagen production while tightening the connective tissues below the surface, making it one of the most effective non-surgical skin rejuvenation treatments available. It’s especially beneficial for patients who notice that their smile lines are more prominent due to sagging or loose skin around the lower face. By targeting both skin texture and structural integrity, Morpheus8 helps deliver improvements in contour, tone, and firmness.

Benefits of RF Microneedling with Morpheus8:

• Firms and tightens sagging skin

• Reduces the depth and visibility of smile lines

• Stimulates collagen and elastin production from within

• Improves skin texture, tone, and elasticity

• Suitable for all skin types with minimal downtime

You can book your RF Microneedling appointment here.

Option #5: Combination Treatments Yield the Best Results

In most cases, smile lines are not caused by a single issue. That’s why we often recommend a combination of treatments to target the multiple factors that contribute to their appearance.

Here’s an example of a typical smile line protocol at MD Skin Lab, for those who seek combination results:

• Midface filler to lift and support the cheek, reducing pressure on the nasolabial fold

• Filler directly into the fold for smoothing

• Microneedling or PRP for fine etched-in lines or skin texture

• Skin tightening treatments like RF microneedling for enhanced collagen stimulation

This layered, strategic approach offers more natural-looking and longer-lasting results, without looking overfilled or puffy. We recommend booking a consultation with a physician injector to create a personalized plan tailored to your skin goals.

When Should I Start Treating Smile Lines?

The best time to start treatment is when you begin to notice folds that bother you, or when you’re ready to take a preventative approach to aging.

• In your late 20s to early 30s, early filler or microneedling can help maintain skin elasticity and prevent deeper folds from forming.

• In your 40s and beyond, volume loss becomes more prominent, and biostimulators like Radiesse or combination therapies can help reverse these signs.

• Regardless of your age, a consultation with one of our physician injectors will help determine the safest and most effective treatment for your specific goals.

What to Expect at Toronto’s MD Skin Lab

When you come in for a smile line consultation, you’ll meet with one of our physician injectors who will evaluate:

• Your facial structure

• Skin tone and texture

• Degree of volume loss

• How your facial movements contribute to line formation

From there, we develop a treatment plan that’s safe, effective, and aligned with your desired outcome—whether that’s subtle rejuvenation or more dramatic correction.

We prioritize natural results, patient comfort, and clinical excellence—always!

Ready to Get Started?

If your smile lines are starting to bother you—or you want to take a proactive approach to facial aging—our physician injectors and senior medical aestheticians are here to help.

Book your consultation at MD Skin Lab and let us show you what’s possible with a science-backed, personalized approach to beauty. We can’t wait to meet you!