Deep mental crease - how can this be improved? (Photos)

Question

I’ve had a very deep mental crease for as long as I can remember I don’t think fillers will help as it’s very deep. What else is an option to soften/remove it ?

Anna Chacon, MD, FAAD · Answer

A deep mental crease (the horizontal fold between the lower lip and chin) is one of those features that can be partly anatomical and partly functional—meaning it can be influenced by both bone structure and how the mentalis muscle moves over time.

When someone has had it for as long as they can remember, it’s often less about aging and more about how the chin and lower lip mechanics interact, sometimes combined with a naturally stronger mentalis muscle pull or a slightly retrusive chin structure that creates a sharper fold.

You’re also right to question filler right away. In some cases, directly filling a deep crease alone can actually make the area look heavy or puffy without truly softening the fold, especially if the crease is very “etched in” or tethered.

Treatment really depends on what’s driving it:

If the crease is primarily muscle-driven, Botox to the mentalis muscle can help relax the pull that deepens the fold. This can soften the crease over time, but it has to be done very precisely—too much weakening can affect lower lip movement.

If there is a structural component, subtle chin augmentation (filler or implant) can sometimes help by improving projection and redistributing tension across the lower face. This doesn’t erase the crease directly, but it can make it significantly less prominent.

If the crease is more skin-etched or fibrotic, then energy-based treatments like fractional laser resurfacing or RF microneedling can improve the texture and collagen remodeling in the area. These work gradually but can soften the “cut-in” appearance over time.

In more resistant cases, a combination approach tends to work best—very conservative Botox to reduce muscle pull, paired with careful structural support of the chin, and skin remodeling treatments if needed.

Surgery is rarely used for this alone, but in cases where chin position is a major contributing factor, genioplasty or chin contouring can be considered as part of a broader facial balance plan.

So while it may not be a single-treatment fix, there are definitely options to soften it meaningfully—it just comes down to identifying whether the crease is primarily muscle, structure, or skin-related, because each layer responds to a different type of treatment.

Nelson Lee Novick, MD · Answer

I have personally treated many similarly deep mental creases in one treatment session with gratifying results by first performing a subcision and then injecting a robust HA Lifting filler. You would be wise to consult with an experienced, board certified cosmetic dermatologist who is both an expert filler injector and has extensive experience in performing subcisions. Hope this helps and best of luck. .

Deep mental crease - how can this be improved? (Photos)

Answers (2)

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