Horizontal line between eyebrows - would fat grafting be the best option? (Photos)

Question

I am 26 years old and have a had a horizontal line between my eyebrows right above my nose that looks like a crease between the transition between nose and forehead I have had this since I was 18 so I’m sure there’s been some volume loss and skin memory over time as it is a static line. I have had two rounds of Botox and even nano fat graft which I later found out doesn’t really adresss volume loss. While it definitely looks better than before what are my options moving forward should I push for micro fat graft to address volume or would laser resurfacing and Botox maintenance be enough at this point?

Carl Truesdale, MD · Answer

A persistent horizontal line in the glabella (between the brows) typically has two contributions and one or the other usually dominates.
Dynamic component (muscle-driven):The procerus and corrugator muscles between your brows pull downward and inward when you frown or concentrate, creating the lines. Over years, these lines become etched into the skin even at rest. Botox or Dysport addresses this directly by softening the muscle activity. Lasts 3 to 4 months per treatment and is the foundation of glabellar line management.
Static component (skin/tissue-driven):Once a line is etched deeply enough that it's visible at complete rest with no muscle activity, you have a structural deficit in the dermis at that location. Botox alone won't smooth out an etched static line &mdash; you need something to fill or remodel the depression.
Where fat grafting fits:Fat grafting can fill an etched glabellar line, but it's not usually the best tool there. The glabella has unique vascular anatomy that makes any injectable in this zone higher risk. Most published cases of injection-related vision loss involve glabellar HA filler, not fat, but fat carries similar risk. Most experienced injectors do this only when other options have been tried.
What I'd actually consider before fat grafting:
Botox or Dysport first, every 3 to 4 months for 12 months. The etched line often softens significantly once muscle activity is consistently relaxed.
Carefully placed HA filler in the deep dermis after the muscle is softened &mdash; only by an injector with specific glabellar experience. Reversible if anything goes wrong.
Microneedling or fractional laser to remodel the dermal collagen in the area. Slower but no injection risk.
If those don't satisfy and you're considering fat grafting, find a surgeon who does glabellar work specifically. The vascular risk is real and surgeon experience matters more than for almost any other facial location.

Horizontal line between eyebrows - would fat grafting be the best option? (Photos)

Answers (1)

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