Horizontal crease above my lips and vertical crease on my chin when I smile, what can I do to fix it? (Photo)

I have been getting Botox injections to fix a gummy smile and I have noticed that I have developed a horizontal crease above my upper lip whenever I smile. This wasn't there prior to me getting the Botox. My doctor injected botox in 3 areas under my nose to get the line to relax but it doesn't seem to be working. Do I have any other options? I also have a vertical crease in my chin when I smile. It extends from the corners of my mouth down to my chin. Can anything be done about this?

Doctor Answers 8

Horizontal Crease in Upper Lip after Botox

Thank you for your question. I do not think Botox has caused the wrinkles. I recommend waiting 3-4 weeks for the Botox to wear off to see if the wrinkles improve. If the wrinkles do not improve after the Botox wears off, then I recommend having them filled with a filler such as Volbella. You can also have them treated with Volbella now if you do not want to wait. Best of Luck!

Summit Emergency Medicine Physician
5.0 out of 5 stars 45 reviews

Location, Location, Location

The gummy smile is more common than you realize.  Injecting the oval-shaped muscle that circumscribes the mouth, in the portion that lays above the upper lip, is only successful in mild cases of the gummy smile.  There is an important muscle that runs on each side of the nose called the Levator Labii Superioris Alaeque Nasi that often needs to be addressed.  I give you this complicated name so that you may address this with your injector with specifics.  I hope this helps.

As to your other question related to the other lines in your lower face, I am sorry, but there is not enough information in the picture to properly address your concerns.  For a more accurate comment, dynamic expression in real time is needed.

David Owers, MD
Vancouver Physician
5.0 out of 5 stars 1 review

Botox for wrinkles around the mouth

Thank you for your question knavarro01. I am sorry to hear about your situation. Botox is a purified protein used to address wrinkles associated with facial expression. In the lower face Botox can be placed on the sides of the nose to address the gummy smile. Sometimes when one muscle is relaxed with Botox (in this case the LLSAN) another muscle (in this case DSN) is recruited to compensate. This is most commonly seen as the appearance of bunny lines when frown lines are addressed with Botox. Botox can be placed in the recruited muscle to address the further wrinkles. Fillers such as Volbella can also be used for wrinkles around the lips. Please consult with a doctor for specific recommendations. Good luck!

Alex Eshaghian, MD, PhD
Encino Physician
5.0 out of 5 stars 3 reviews

Horizontal crease above lip after Botox injection

I'm not sure that the Botox injections caused this crease to form although the timeline suggest it did. That being said, you could wait for the Botox to wear off and see if the line improves. If the line doesn't improve after the Botox wears off, then I would treat it with a filler such as Volbella. If you do not want to wait for the Botox to wear off, you could also have the filler injected sooner. Hope this helps.

Shaun Patel, MD
Miami Physician
5.0 out of 5 stars 55 reviews

Horizontal Lines above Lips from Botox

It sounds from your description that Botox caused this wrinkle.  I would expect the lines to disappear once the Botox has dissolved.  In the meanwhile Volbella should help treat this area very well.  Please consult an expert.  Best, Dr. Green

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 76 reviews

Horizontal crease in upper lip after Botox

My guess is that the line is going to be there even if the Botox wears out. I would do just that. If still there, inject with filler. The marionette lines can be help with filler too. 

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.7 out of 5 stars 41 reviews

Horizontal crease above my lips and vertical crease on my chin when I smile. What can I do to fix it?

Thank you for sharing your question and photograph.  This appearance can result with Botox placement into the upper lip and is best treated by either avoiding botox injections into the upper lip, or placing them more along the outer corners of the nose.  Fillers can be placed now to try and improve upon this current crease appearance.  Hope this helps.

Nelson Castillo, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 65 reviews


Thanks for this question. The relaxation of the muscles there are likely contributing to the formation of the creases. Perhaps, next time lowering the dose might prevent this. At this point, you can consider filling the creases with a fine HA filler like Restylane Silk. Speak with your injector, Best. Dr. ALDO

Aldo Guerra, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 201 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.