What Causes a Horizontal Crease Above Upper Lip (Beneath Nose) when I Smile?

 This is usually due to a short upper lip, strong muscle contraction, and a prominent nasal spine, and columella, and depressor septi ligament. Botox may help with his area however it will slightly reduce the smiling ability since it is a paralytic agent.  A rhinoplasty would reduce  the tethered nasal tip,  resection of the caudal septum and releasing  and active depressor septi ligament can also help in this area.

Great question. This is usually mostly driven by muscles we all have in that region. The depressor septi nasi and the orbicularis oris muscle mostly. As those contract, they can form a horizontal line around your upper lip between the lip and the bottom of the nose. Most people don't get an obvious crease, but some do. If it is really bothersome you can have botox injected there and it will reduce the crease. Otherwise if you are planning on having a rhinoplasty done, the depressor septi nasi muscle can be cut, as we often do this to prevent plunging of the nasal tip with smiling, and it should soften or resolve the crease as well more permanently. Good luck!
-Dr. David Mattos, New York Plastic Surgical Group

  This could be due to muscle bunching in that area, but a photo would help pin down the cause.  Kenneth Hughes, MD Los Angeles, CA