How Can The Dent In My Glabella Be Fixed?

Q: Dr. Eppley, I am inquiring about two issues that I currently have. One is my lip shape/size. I was interested in possibly getting either a fat graft to my lips or a vermilion advancement of both my upper and lower lips, but I had a v-y advancement last September, and am unsure if I would be a candidate for either of these procedures due to the scarring on the inside of my lips. I also have a downturned corners of my mouth and was hoping to a lift in conjunction with one of those procedures. Secondly is the dent in my glabella region. I am 24 years old, and have been diligent with skincare for many years so it’s troubling that I have such a prominent wrinkle (or deep groove in my case). I notice it in every photo and was hoping for insight. I have tried botox twice, which has been unsuccessful at getting rid of it, and don’t know if it’s a lack of volume issue or strong corrugator muscle issue. I know fat grafting, is an option, as well as (potential) implants, but I was wondering if corrugator muscle surgery would be beneficial as well?

A: Thank you for your inquiry and sending your pictures to which I can say the following:

1) The inner scarring from the previous V-Y plasty does not have any effect on any external excisional lip procedures.

2) For the upper lip you need to consider a subnasal lip lift combined with lateral vermilion advancements with corner lifts. You don’t want to run a scar line across your well defined cupids bow in your case.

3) for the lower lip I would be cautious about any vermilion advancement is it already has a decent size. I don’t know if you had a V-Y on the lower lip but, if not, that would be an option to consider.

4) For the glabellar dent this does  appear to be a volume issue and I’m not surprised that Botox would have no positive affect on it. Since this is an area where injections are to be avoided a solid fat graft placement underneath it is an option. I would be very cautious about corrugator muscle release as in my experience it solves one problem and then causes other ones to the side of the release.

Dr. Barry Eppley

Plastic Surgeon