Horizontal Crease Above Upper Lip After Filler: Treatment and Care

Medically Reviewed
Medically Reviewed by Dr. Aurora Kalmanson on
Written by Fillers Editorial Team, plastic surgery specialists.

A horizontal crease above the upper lip post-filler treatment can be a disconcerting aesthetic concern. This unintended outcome is often the result of overfilling or the natural accentuation of a pre-existing line.

While the crease may become more pronounced when smiling, it can also be due to the migration of the filler beyond the lip area, creating a shelf-like appearance or a shadow that resembles a moustache. Treatment options vary from enzymatic degradation of the overfilled area to additional filler application above the lip line, with the goal of achieving a smooth, natural look. Understanding the underlying causes and exploring appropriate corrective measures is essential for those seeking to address this issue.

Understanding the Cause of Horizontal Crease Above Upper Lip After Filler

The appearance of a horizontal crease above the upper lip after filler injections can be perplexing. It’s important to delve into the reasons behind this occurrence to determine the most effective treatment strategy.

Overfilling of the Upper Lip

Lip Pushes Upward When Smiling: When the upper lip is overfilled, it can lead to a pronounced crease as the lip pushes against the skin above it during a smile. This effect is due to the added volume from the filler, which forces the lip to extend beyond its natural boundary and press upwards. The muscle movements associated with smiling exacerbate this, making the crease more visible. Over time, the repeated action of smiling can cause the skin to crease more readily, potentially making the line more permanent. It’s crucial to address this issue promptly to prevent long-term aesthetic concerns.

Filler Migration Out of the Lip: Filler migration is another factor that can contribute to the formation of a horizontal crease above the upper lip. When fillers are not injected precisely or when they spread beyond the intended area, they can create an unnatural contour. This migration can result in a distinct separation between the lip and the skin above it, manifesting as a crease. The migrated filler can also create a fuller appearance above the lip, which is not in harmony with the rest of the facial features. Addressing filler migration requires careful correction to restore a balanced and harmonious lip contour.

Treatment Options for Horizontal Crease Above Upper Lip After Filler

Various treatment strategies can be employed to address the horizontal crease above the upper lip after filler injections, ranging from Botox to additional filler applications.

Botox Injections

Proper Placement and Dosage Considerations: The success of Botox in treating a horizontal crease hinges on precise placement and appropriate dosage. An experienced injector will carefully assess the muscle dynamics and facial anatomy to determine the optimal injection sites and the amount of Botox needed. The goal is to achieve a balance that softens the crease without compromising the natural movement of the lip. Dosage adjustments may be necessary over time to maintain the desired effect while ensuring patient safety and satisfaction.

Additional Filler Above the Lip Line

Restoring Volume to the Upper Cutaneous Lip: To address the horizontal crease above the upper lip, additional filler can be strategically placed in the upper cutaneous lip area. This technique aims to restore lost volume and create a smoother transition between the lip and the surrounding skin. By filling the area above the lip line, the skin’s surface can be evened out, reducing the appearance of the crease. It’s essential to use a soft, malleable filler product that blends smoothly with the natural tissue, ensuring a subtle and natural-looking enhancement.

Careful Injection Technique to Avoid Lumps and Bumps: Achieving a smooth result with fillers necessitates a meticulous injection technique. The injector must be adept at placing the filler at the correct depth and using the right amount to prevent the formation of lumps and bumps. It’s also important to massage the area gently after injection to ensure the filler integrates smoothly with the existing tissue. Patients should be advised on the importance of selecting a qualified and experienced injector to minimize the risk of irregularities and to ensure the best possible outcome.

Natural Dissolution of Filler Over Time

Waiting 4-6 Months for Filler to Dissipate: In some cases, the best approach to addressing a horizontal crease above the upper lip after filler is to simply wait for the body to naturally break down and absorb the filler material. Most hyaluronic acid fillers will gradually dissipate over a period of 4-6 months, depending on the product used and the individual’s metabolism. During this time, the appearance of the crease may improve as the volume of the filler decreases. Patients should be counseled on the expected timeline for natural dissolution and may choose to combine this approach with other treatments to enhance the overall aesthetic result.

Frequently Asked Questions

Is the horizontal crease above the upper lip after filler permanent?

No, the horizontal crease is typically not permanent. It may diminish as the filler naturally breaks down over time.

Can the horizontal crease above the upper lip be prevented when getting lip filler?

Yes, by using careful injection techniques and avoiding overfilling, the risk of developing a horizontal crease can be minimized.

What is the best treatment option for the horizontal crease above the upper lip after filler?

The best treatment varies but may include additional filler, Botox injections, or enzymatic degradation with hyaluronidase.

Should I get more filler to correct the horizontal crease above my upper lip?

It depends on the cause of the crease. Consult with a professional to determine if more filler or another treatment is appropriate.

Can Botox alone fix the horizontal crease above the upper lip after filler?

Botox can help if the crease is due to muscle activity, but it may not be sufficient if caused by other factors.

Will the horizontal crease above my upper lip worsen with additional filler?

It could if not done correctly. It's important to address the underlying cause before adding more filler.


In conclusion, while the development of a horizontal crease above the upper lip after filler injections can be a concern, it is often a treatable condition. Understanding the causes and exploring various treatment options can lead to satisfactory outcomes. Preventive measures and careful injection techniques are key to avoiding such issues. If a crease does occur, seeking professional advice promptly can help determine the best course of action. With the right approach, individuals can achieve their desired aesthetic goals and maintain the health and beauty of their lips.

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Vardimon, A. D., Shpack, N., Wasserstein, A., Skyllouriotou, M., Strauss, M., Geron, S., Sadan, N., Levartovsky, S., & Sarig, R. (2020). Upper Lip Horizontal Line: Characteristics of a Dynamic Facial Line.

Dr. Aurora Kalmanson

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The information provided in this blog is for informational and educational purposes only and should not be interpreted as personalized medical advice. It's crucial to understand that while we are medical professionals, the insights and advice we provide are based on general research and studies. They are not tailored to individual health needs or conditions. Thus, it is essential to consult directly with a healthcare provider who can offer personalized medical advice relevant to your specific situation.