How to fix a crease that runs horizontally across bridge of nose between the eyebrows? (Photo)

Fillers and botox are temporary helpers but you really want something long term such as a brow lift which cuts the muscle/skin permanently and elevates the tissue which is a big procedure OR a soft ptfe implant that fills in the crease permanently $1500 under local and takes 5 minute to do. Sincerely, David Hansen,MD

The horizontal brow crease in the glabellar region is caused by procerus muscle hypertrophy and activity. Vertical lines are caused by corrugator muscle activity and hypertrophy. Both these lines can be lessened and smoothed with neuromodulator injections, either with Botox or Dysport. For a powerful glabella, Dysport may be a good first choice because it is more powerful than Botox. Approximately 60 to 70 units of Dysport in this region would be a good start, and persistent lines could be decreased with a filler. Neuromodulators will last approximately 3 months in this region. More permanent solutions would be surgical excision of the corrugator and procerus muscles, either through the upper eyelid or via an endoscopic browlift.

Thank you for your
question. Creases in this area are commonly related to muscle activity. The muscle contacts and creates a crease that over time can get deeper and deeper. The use of neuromodulators such as botox, dysport or xeomin can prevent the muscular activity and prevent the formation of creases and soften creases that are already present.At times, the creases have been present for such a long time that simply preventing muscle activity does not give you the result you are looking for. It's like when you fold a piece of paper over and over and then try to iron it - it doesn't always remove the crease. For these situations, filler can be considered.

It is important to
realize that any opinion given here does not replace the value of a face-to-face
consultation. An evaluation without examining you, physically feeling the
tissue, assessing your desired outcome, taking a full medical history, and
discussing the pros and cons of the proposed procedure with you may not be in your best
interest. I would recommend you find a facial plastic surgeon in your area that you trust and feel comfortable
with to discuss your concerns.

Good luck!

Marcelo Antunes MD

Botox or Xiomen relaxes the muscles the cause the crease. If the crease is deep or has been there for awhile then fillers are usually required. If it is more severe then a browlift may be indicated. Make sure you find an experienced surgeon who is a member of the Anerican Board of Plastic Surgery.

If the crease has been worsening with time, Botox (or another neuromodulator) may be extremely effective. If it has been there all of your life or at least many many years, a filler (or a combination of filler and Botox) may be required. A proper in-person evaluation is essential.

Most physicians would recommend the use of a neuromodulator for this problem. This includes Botox, Dysport and Xeomin. These products inhibit muscle contraction where injected and generally these creases in the glabellar area (between the brows) are caused by contraction of the corrugator and procerus muscles. Over time these muscles get bigger (the same way other muscles can get bigger from working them out). Botox and other neuromodulators stop them from "working out" and over time and with repeated treatments they will get smaller and the creases less noticeable. So first step would be Botox or one of the equivalent medications. Next for persistent creases a little bit of a soft tissue filler can be used, but make sure the doctor performing the procedure has extensive experience injecting soft tissue fillers since significant complications can arise in using soft tissue fillers in this area. Good luck.

You describe a problem that is more common in men than women.  Botox can soften the heavy ridge above the brows that you describe.  A more complete solution would be a surgical brow lift.  In between these two options would be Ulthera with a cosmetic surgeon that has experience in adding extra lines in the brow area to create more lift.