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

Question

I am 42 years old, have never had any facial work done and have recently noticed that when I smile I have a very noticable horizontal fold or raised pouch of skin beneath my nose that measures about 1-1/2" long. What could cause this and more importantly, are there any non-surgical ways to lessen or get rid of it?

Ali Sajjadian, MD, FACS · Answer

Thanks for your question . A horizontal crease above the upper lip when smiling is often caused by the activity of certain facial muscles, particularly the depressor septi nasi muscle. This muscle pulls down the nasal septum and can contribute to the formation of the crease . The strength of the levator labii superioris muscle, which raises the top lip, is one of the other variables that may affect how this crease appears.  
Although many individuals consider this wrinkle to be a normal aspect of face expression, others may find it unattractive. Speak with a Board Certified Plastic Surgeon about your choices for treatment if you're worried about how this crease looks. These might consist of:
Botox injections: By momentarily paralyzing the muscles causing the wrinkle, botulinum toxin injections might lessen its visibility.   
Dermal fillers: To soften the look of the crease and give the lips more volume, fillers can be injected into the affected region.   
Surgical operations: To treat the underlying muscle activity or to elevate the surrounding tissues, surgical techniques may be considered in some situations.
To find the best course of action for your unique requirements and concerns, it's crucial to speak with a certified healthcare practitioner.   
Hope this was helpful!
Best wishes,
Dr Ali Sajjadian 
TRIPLE Board Certified Plastic Surgeon

Jeffrey Lisiecki, MD · Answer

This is often from the activity or pulling of a muscle called the depressor septi which basically goes from your nose to your upper lip.  Nonsurgically, a little botox in this muscle often lessens or eliminates it.  Surgically, a this muscle can be released on its own or during a rhinoplasty procedure.

Thomas Buonassisi, MD · Answer

At 42, it's common to start noticing changes in skin elasticity and volume, especially around the mouth and nose area. The horizontal fold or raised pouch you describe could be caused by a combination of factors, including natural aging, loss of collagen and elastin, sun exposure, and repetitive facial movements. Non-surgical options to help lessen or improve this area include treatments like dermal fillers, which can restore lost volume, botox, which can soften dynamic wrinkles and skin tightening procedures such as radiofrequency or ultrasound therapy. Additionally, a good skincare routine that includes hydration and sun protection can help maintain skin health. Consulting with a skincare professional can provide personalized recommendations tailored to your needs.

Kenneth Hughes, MD · Answer

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

Nima Shemirani, MD · Answer

Dear cibell2000,

	
		To be sure, you would need an exam to see what the cause is
	
		It could be related to your septum, and it sounds like the skin is bunching up against something
	
		When you are ready, seek out a consultation with a plastic surgeon who can address all of your concerns and questions


	Best regards,

	Nima Shemirani

David Mattos, MD · Answer

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

William Portuese, MD · Answer

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.

Steven Wallach, MD · Answer

The transverse crease above your upper lip has most likely developed from repeated motion of the muscle. Sometimes a neurotoxin can help this. Sometimes a filler product can camouflage it. Best to be seen in person to determint the best treatment.

Tal T. Roudner, MD, FACS · Answer

Sounds like lines that are forming from the contracting muscles that raise your upper lip and depress your nasal tip. This could be corrected by a straight forward procedure but consult with a board certified plastic surgeon to get an accurate diagnosis.

	Good luck

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

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