A deep furrow between the lower lip and the chin, the labiomental crease, which may resemble an upside down smiley face, may result from a family trait predisposition or more typically follows years of use of the surrounding muscles of facial expression. While considered one of the signs of facial aging, it can be seen in younger people as well.
Fortunately, most instances of these deepening clefts can be improved with the use of volumizing fillers, such as Radiesse or a combination of Radiesse and Perlane L--both of which are excellent lifting agents and the ones I use in my Upper East NY practice. In my Israel practice, where a greater number of regulatory agency approved products are available, I prefer to use the more robust version of Perlane, Restylane SubQ, either alone or in combination with Radiesse for this purpose.
In most cases, volumizers are sufficient to give the necessary lift to correct the problem. However, in instances where additional improvement may be needed, subcision may be performed. Subcision, a minimally invasive technique requiring only local anesthesia, entails the use of a fine needle inserted directly under the depression and moved from side to side to break up any fibrous tissue bands that may be pulling the overlying skin downward. Once freed from these fibrous tethers, the overlying skin can "float" to the surface and volumizing fillers can then be added (I prefer to do so at the same treatment session to eliminate the need for a second visit) to fill the newly created space below the crease and to further buttress the improvement and potentially prolong the benefits of treatment.
Occasionally, if the muscles of facial expression around the crease, such as those that give rise to the pebbly appearance of the chin or the marionette lines appear to be contributing to the problem, a few microdroplets of a neuromodulator, such as Botox, Dysport, or Xeomin, may be instilled in these surrounding areas to achieve additional improvement of the entire aesthetic unit.