40 year old female - horizontal crease between eyes. What can be done to remove it permanently? (Photo)

Hi aliinsocal. They are correct that this line most likely formed from an overactive procerus- you will need to do regular and prolonged tox injections before you see a change, esp if it is really set in. However, if you are thinking about surgical options (which might even be necessary depending on your anatomy), from what I can see, it is possible that your medial brows are a little low and the excess hanging is causing the extra skin to bulge right there. Another possibility is if you have an extremely deep radix or the starting point of your nose, it could mean that skin is always going to have a tendency to sit there, in which case you might want to consider something to permanently build up this area (not filler), such as possibly fat grafting and/or cartilage grafting. Good luck!

In my experience, this problem is not that uncommon. When the combination of Botox and filler alone have not yielded gratifying results (although they typically do when combined and when Botox is employed by an experienced injector in the appropriate concentration and amount and the proper filler injected in an appropriate fashion), then subcision, a simple and relatively inexpensive technique for permanently elevating all kinds of indentations. Surgical excision runs the risk for the subsequent development of stretch scars and tram track stitch marks. You would be wise to consult with an experienced, board certified cosmetic dermatologist and best of luck.

The horizontal crease between your eyes, also known as the glabellar line, is indeed caused by the repetitive contraction of the procerus and corrugator supercilii muscles. While Botox and fillers can significantly reduce the appearance of this line, they cannot completely eliminate it.
For a more permanent solution, a surgical procedure called a Corrugator Supercilii Muscle Resection (CSMR) might be considered. This procedure involves removing or weakening the muscles that cause the crease, thereby reducing its appearance. However, this is a significant surgical procedure and not without risks. Potential side effects include asymmetry, changes in sensation, and possible changes in the ability to express emotions through facial movements.

I encourage you to begin by visiting with a board certified plastic surgeon near you. Botox is typically helpful in improving lines like this one. You may consider laser resurfacing or Morpheus8 treatments. If the brows are low a brow lift may help.

As a non-invasive Aesthetic Dermatologist, I can accomplish a lot without any surgery. There are occasions when surgery is in fact your best option. I review these choices with my patients and if appropriate help them to get to a Plastic Surgeon who can better address their needs.
This may be the case with you. The furrow that is horizontal and present at rest may indicate laxity in the forehead area. A good choice may in fact be a browlift. Consult a board certified Plastic Surgeon to learn your options.

Thank you for your photo and your question.
It is such a simple thing to fix in one visit with just appropriately placed and dosed botox and some filler.The result can last 1 year or longer. You definitely do not need surgery. You just need to find an experienced snd knowledgeable provider near you or travel to see one if needed. Virtual consultation are a great way to get more information about the treatment before traveling.It is not something that a beginner injector understands or knows how to address so please do a good research. It is a very simple an easy fix in 1 visit.
Have a beautiful day, Best. Dr.Anna Avaliani, NYC

Neurotoxin can actually make this worse since the muscle relaxation will cause the bulk to rest down with gravity more. I recommend a surgical evaluation for endoscopic versus trichophytic browlift as it may lift the soft tissue of the forehead that is heavy in this area.