How can I treat the hooks above nostrils nasalis or labii superioris alaeque nasi? (Photos)

Question

I've always had these folds above my nostrils when I smile. Once I got botox in my 11s and depressor septi nasi and it made it way worse. What was compensating here, and where would I treat this again?

Anna Chacon, MD, FAAD · Answer

From your photos and description, it looks like you're referring to the natural folds that form alongside the upper nostrils when you smile. These are often created by a combination of your facial anatomy and the way the muscles around the nose and upper lip work together.

One clue is that you noticed the folds became more pronounced after Botox to the depressor septi nasi and glabellar ("11") area. That can happen because relaxing one muscle group sometimes allows neighboring muscles to become more dominant. The muscles that elevate the upper lip and nostril—particularly the levator labii superioris alaeque nasi (LLSAN) and portions of the nasalis—may become more noticeable during smiling if they're no longer being balanced by surrounding muscle activity.

It's also important to remember that these folds aren't always caused by muscle alone. The thickness of the skin, the amount of subcutaneous fat, the shape of the nose, and the way your cheeks lift when you smile all contribute to what you're seeing. In many people, these are simply normal dynamic expressions rather than a sign of aging.

Because of that, there isn't a single injection point that works for everyone. Treating the LLSAN or nasalis with a very small amount of neuromodulator may soften excessive muscle pull in carefully selected patients, but over-treating these muscles can affect your smile or upper lip movement. Since you already noticed an unwanted change after your previous Botox treatment, I'd be especially cautious about adding more toxin in that area without first identifying exactly which muscles are responsible.

If volume loss is also contributing, a small amount of filler in the surrounding tissues may sometimes improve the transition rather than weakening the muscles. In other cases, no injectable treatment is the best option if the folds are simply part of your normal facial expression.

The most effective approach starts with watching your face in motion—not just at rest—to determine whether the folds are primarily muscle-driven, volume-related, or simply a natural feature of your anatomy. That evaluation helps guide treatment while preserving a natural smile.

How can I treat the hooks above nostrils nasalis or labii superioris alaeque nasi? (Photos)

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