What will fix a snarl? Is there anything more permanent than Botox? (Photos)

Question

I heard Botox may temporarily relax the muscle but is there anything more permanent? I really don’t want to do any Botox.

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your concerns and photos. I understand wanting a more lasting solution than Botox for the “snarl” lines—the area between the eyebrows (glabellar region) can be stubborn and expressive.

Here’s a breakdown of options beyond temporary muscle relaxers:

Neuromodulators (Botox, Dysport, Xeomin)
As you mentioned, these temporarily relax the muscle, usually lasting 3–4 months.
They are reversible and low-risk, but require repeat treatments to maintain results.
Chemodenervation Alternatives
There are no truly permanent non-surgical neuromodulators currently available. Any chemical muscle relaxation is temporary.
Surgical Options
Direct brow lift or glabellar muscle modification can reduce the muscle action permanently.
Procedures like a forehead lift or selective levator muscle weakening can soften snarling long-term.
Surgery is more invasive, requires downtime, and is typically reserved for those seeking a lasting solution.
Dermal Fillers
Fillers don’t relax the muscle, but strategically placed filler can smooth the area and reduce the appearance of a snarl.
Results last 9–18 months depending on the product.

Summary:

Botox is temporary and non-surgical, but if you want a permanent reduction in snarl lines, surgical modification of the muscles or a brow/forehead lift is the main option.
Fillers can complement this or provide a less invasive improvement but won’t stop the muscle from moving.

Essentially, there’s no permanent non-surgical solution; lasting correction requires surgical intervention if you want to avoid repeat injections.

Jeffrey H. Spiegel, MD · Answer

A corner lip lift can adjust the snarl and is a fairly permanent solution. It's done with a few well camouflaged stitches right along the lip line, and can be done in the office.

Gary M. Horndeski, MD · Answer

Your nose is slightly curved to the right side, your right lip is higher and your right chin is somewhat higher than the left chin. You may benefit from a rhinoplasty to help straighten your nose. You would also benefit from an eccentric lip lift, not a bullhorn lip lift. This does 4 things: shortens the distance between your nose and upper lip, increases the mucosa of the upper lip, increases the incisor show and pulls up the corners. You may also benefit from a chin implant, which is done intra-orally so there are external scars.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

What will fix a snarl? Is there anything more permanent than Botox? (Photos)

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