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

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

Answers (9)

Answer: Horizontal Line Under Nose When Smiling

Answer: Horizontal Line Under Nose When Smiling

Answer: Smile lines

Answer: Smile lines

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

Answers (9)

Answer: Horizontal Line Under Nose When Smiling

Answer: Horizontal Line Under Nose When Smiling

Answer: Smile lines

Answer: Smile lines

Browse related questions

Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.