How to Fix Gap Between Upper Nose and Forehead? (photo)

I think your best bet is to inject the gap with local anesthetic or saline which temporarily fill the gap and see if you like how it looks. If you like it then decide whether you want an injectable filler, implant or cartilage graft. Each approach has its own specific pros and cons. If filling the gap does not look good than you will have to remove some soft tissue or bone to get the desired result.

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There are several possible approaches to this problem including nasal root (radix) augmentation with or without rhinoplasty (prefabricated porous polyethylene graft is available and works very well), hairline open browlift (even if crease is effaced by graft, brows appear heavy and low, browlift would "open up" and lighten your expression, and more temporary solutions such as Radiesse injection.  Direct excision with grafting is certainly a possibility, but would be last on my list.  Although inexpensive and permanent, the resulting scar, although most likely obscure, would be permanent, and this approach would not lift your brows at all.

      If this is a skin laxity issue, excision of this area or a modified brow lift may work well.  Fillers can be used but may not work as well depending upon the depth of the crease.  If fillers are used, this should be done with a blunt cannula.  If this is a muscle mass issue, Botox may be able to improve the area.  A physical exam in animation will be best in your situation.  Find a plastic surgeon with ELITE credentials who performs hundreds of rhinoplasties and rhinoplasty revisions each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA