Addressing the 'Mentalis Crease': Smoothing the Horizontal Indentation Below the Lip

Many people notice a horizontal line or indentation running across the chin, just below the lower lip, that becomes more visible with age or in certain facial expressions. This feature — commonly referred to as the mentalis crease — is a topic of increasing interest among patients researching facial rejuvenation options in London and across the UK.

The mentalis crease can be a naturally occurring anatomical feature in younger individuals, but for many people it deepens over time as a result of repetitive muscle movement, volume loss, and changes in skin quality. Some patients find that it creates a visual shadow beneath the lip, contributing to a tired or aged appearance even when they feel well-rested.

Understanding what causes the mentalis crease, how it differs from other perioral concerns, and what treatment approaches may be considered during a professional assessment are all important steps before exploring any aesthetic procedure. This article aims to provide clear, balanced, and educational information to help you make informed decisions and know when a consultation with a qualified practitioner may be worthwhile.

The mentalis crease is a horizontal indentation located below the lower lip, caused by the underlying mentalis muscle, volume changes, and skin laxity that develop with age. Aesthetic treatments such as anti-wrinkle injections or dermal fillers may help soften its appearance in suitable candidates, though outcomes vary individually and are assessed during professional consultation.

The mentalis is a paired muscle located at the tip of the chin. Its primary function is to elevate the lower lip and chin skin — it plays an active role in expressions such as pouting, doubt, or emotional tension. Because this muscle contracts frequently throughout daily life, the overlying skin is subject to repeated mechanical stress.

In younger skin, strong collagen and elastin fibres allow the skin to spring back after each contraction. However, as these structural proteins gradually diminish with age, the skin becomes less resilient. Over time, the repeated folding of skin along the muscle's line of pull creates a permanent crease, visible even at rest.

Additionally, the redistribution of facial fat that occurs naturally with age can reduce the volume in the chin and perioral area. This loss of soft tissue support means the skin is no longer held as firmly in position, allowing creases to become more pronounced. Genetic factors, body weight changes, and lifestyle habits such as sun exposure can all influence the rate at which this process occurs.

Understanding this mechanism is important because it informs why a single treatment approach is rarely sufficient — and why a thorough assessment of the underlying anatomy is essential before any treatment is considered.

The perioral region — the area surrounding the mouth — is one of the most complex zones of the face from an aesthetic standpoint. Several distinct types of lines and creases can develop here, each with different causes and treatment considerations.

Smoker's lines (also known as lipstick lines or perioral rhytids) are fine vertical lines that radiate outward from the lip border. They result from repetitive pursing motions, sun damage, and collagen loss within the lip skin itself.

Marionette lines run vertically downward from the corners of the mouth towards the chin, caused largely by volume loss and soft tissue descent.

The mentalis crease, by contrast, is a single horizontal indentation that runs transversely across the chin below the lower lip. It is primarily driven by the contraction of the mentalis muscle and the structural changes that occur at the skin–muscle interface.

Correctly identifying the type of perioral concern is essential, as different features may respond differently to various treatment approaches. A qualified practitioner will assess each zone individually during consultation and will not make assumptions about which treatment — if any — is appropriate without a thorough clinical review.

To appreciate why the mentalis crease develops and deepens, it helps to understand the biological processes underlying facial skin ageing.

Collagen is the primary structural protein in skin, forming a dense network of fibres that provide firmness and support. From the mid-twenties onwards, collagen production begins to decline — a process that accelerates in women following the menopause, when oestrogen levels fall significantly. As collagen diminishes, skin loses its structural scaffolding and becomes less resistant to the mechanical forces created by muscle movement.

Elastin fibres, which allow skin to return to its original position after stretching or folding, similarly degrade with age and with cumulative UV exposure. When elastin function is compromised, creases formed during facial expression are less likely to fully resolve when the face returns to a neutral position.

Hyaluronic acid, a naturally occurring molecule in the skin's dermis, plays a key role in skin hydration and volume. It binds water molecules and contributes to the plumpness and resilience of healthy skin. With age, hyaluronic acid levels decline, reducing skin hydration and contributing to a loss of soft tissue volume in the lower face.

Together, these processes create the conditions in which the mentalis crease becomes more visible and persistent — a combination of reduced skin quality, muscle-related tissue folding, and volume depletion.

Several aesthetic treatment approaches may be discussed during a professional assessment for the mentalis crease. It is important to note that no single treatment is appropriate for everyone, and the suitability of any approach depends entirely on individual anatomy, skin condition, and clinical assessment.

Anti-wrinkle injections (botulinum toxin): Botulinum toxin is a prescription-only medicine (POM) in the UK, available only following a prescription from a suitably qualified prescribing practitioner. When the mentalis muscle is identified as a primary contributing factor, small doses may be considered to reduce the intensity of muscle contraction. This can allow the overlying skin to relax and the crease to appear less pronounced. The effect is temporary, typically lasting three to six months, and requires repeat treatment to maintain results. This approach requires careful technique, as the mentalis muscle is closely related to lip movement, and assessment of lower facial anatomy is critical.

Dermal fillers: Where volume loss beneath the lip or within the chin is contributing to the appearance of the crease, hyaluronic acid-based dermal fillers may be discussed as a way to restore soft tissue support. Fillers can help lift and smooth the affected area, though results vary and carry their own risk profile, which a practitioner will explain fully during consultation.

Skin boosters and polynucleotides: For patients whose primary concern relates to skin quality — dryness, thinness, or poor texture — injectable skin hydration treatments or polynucleotide therapies may be considered as part of a broader skin health strategy. These treatments work to improve the quality and resilience of the skin itself rather than directly addressing muscle activity or volume.

No treatment decision should be made without a comprehensive in-person assessment by a suitably qualified practitioner.

If you are noticing a horizontal indentation below your lower lip that has become more visible over time, or that you feel affects your facial appearance in a way you would like to understand better, a professional consultation may be a helpful next step — not to commit to any treatment, but to gain clarity.

A consultation with a qualified aesthetic practitioner may be worthwhile if you are experiencing:

A deepening crease or horizontal line below the lower lip that has become more noticeable with age A sense that the chin area appears flattened or indented when you look in the mirror Concerns about the overall appearance of the lower face or perioral region Questions about whether non-surgical options exist and what they involve Uncertainty about whether what you are seeing is related to muscle activity, volume loss, or skin quality

A professional assessment allows a practitioner to examine your anatomy in person, explain what may be contributing to your specific concern, and — where appropriate — discuss the range of options that may or may not be suitable for you. For those based in London, an aesthetic consultation at Pantaleo Clinic offers an opportunity to explore these questions in a clinical, patient-centred environment.

There is no obligation to proceed with any treatment following a consultation.

It is important to approach any aesthetic treatment with a balanced and realistic perspective. Below is an overview of what patients may and may not expect when exploring treatment options for the mentalis crease.

Potential benefits that may be discussed: A softening of the horizontal indentation in suitable candidates Improved skin hydration and quality in the perioral region over time A more rested or harmonious appearance of the lower face Increased understanding of one's own facial anatomy and ageing process

Realistic expectations: Results are not permanent for any currently available non-surgical treatment The degree of improvement varies considerably between individuals Multiple treatment sessions or a combination approach may be required The goal of most treatments is improvement rather than elimination Results depend on anatomy, skin quality, the severity of the crease, and the treatment chosen

Possible limitations: Some creases — particularly those that are deep and long-established — may not respond significantly to non-surgical intervention alone Botulinum toxin in the lower face requires particular care to avoid affecting lip or jaw movement Fillers carry risks including bruising, swelling, and rarer but more serious complications, which should be discussed in full Skin quality treatments require time and consistency to deliver visible change Individual response to treatment is not predictable in advance

Whether or not you choose to explore aesthetic treatment for the mentalis crease, maintaining good skin health in the perioral region is beneficial at any age. The following evidence-informed habits can support skin resilience and slow the visible effects of ageing in this area.

Daily broad-spectrum sun protection is one of the most well-evidenced strategies for reducing the rate of collagen and elastin degradation. UV radiation contributes significantly to premature skin ageing, including the deepening of perioral creases. An SPF 30 or higher applied consistently — even on overcast days — is advisable for most adults.

Skin hydration: Keeping the skin adequately moisturised supports barrier function and helps maintain a plumper, more resilient appearance. Look for formulations containing hyaluronic acid, ceramides, or niacinamide for the perioral and lower face area.

Retinoids: Where appropriate and tolerated, topical vitamin A derivatives (retinoids) are among the most evidence-supported ingredients for stimulating collagen production and improving skin texture. Patients new to retinoids should introduce them gradually and seek guidance from a skincare professional.

Lifestyle factors: Adequate sleep, a balanced diet rich in antioxidants, not smoking, and staying well-hydrated all contribute to skin health over time. These are not substitutes for clinical treatment, but they provide a meaningful foundation for skin quality.

If you have undergone an aesthetic procedure, follow all aftercare instructions provided by your practitioner carefully, including guidance on avoiding certain products, activities, or sun exposure during the recovery period.

The mentalis crease is a horizontal indentation below the lower lip, influenced by muscle activity, volume loss, and changes in skin quality over time. It is distinct from other perioral concerns such as smoker's lines or marionette lines, and requires individual assessment to determine the most appropriate approach. Several aesthetic treatment options — including anti-wrinkle injections, dermal fillers, and skin quality treatments — may be discussed during a professional consultation, though no approach is universally suitable. Results from non-surgical treatments are temporary and vary between individuals; realistic expectations are essential. Good daily skincare, including sun protection and skin hydration, supports skin health regardless of treatment choices. A professional consultation is the appropriate starting point for anyone considering aesthetic treatment in this area — it provides information without obligation.

Is the mentalis crease the same as a chin dimple?

Not exactly. A chin dimple (or cleft chin) is a structural feature caused by the underlying bone or how the mentalis muscle attaches, and it typically runs through the middle of the chin vertically. The mentalis crease, by contrast, is a horizontal line or indentation that runs across the chin just below the lower lip. Both features are influenced by the mentalis muscle, but they represent different anatomical characteristics and are addressed differently during clinical assessment.

Can anti-wrinkle injections treat the mentalis crease safely?

Botulinum toxin injections into the mentalis muscle may be appropriate for some individuals, but this area requires careful assessment and precise technique. The mentalis is closely connected to the function of the lower lip, and incorrect placement or dosing can temporarily affect lip movement or expression. A qualified and experienced practitioner will assess your anatomy in detail before recommending this approach, and will discuss the risks, realistic outcomes, and alternatives during consultation. This treatment is not suitable for everyone.

How long do results typically last for mentalis crease treatments?

This depends on the type of treatment used. Anti-wrinkle injections typically last between three and six months before a repeat treatment may be considered. Dermal fillers used in the chin or perioral area may last longer — often between nine and eighteen months — though this varies depending on the product used, the individual's metabolism, and lifestyle factors. Skin quality treatments such as polynucleotides or skin boosters generally require an initial course followed by maintenance sessions. A practitioner will discuss realistic longevity expectations during consultation.

Does the mentalis crease get worse with age?

For many people, the mentalis crease does become more visible over time. This is because the collagen, elastin, and hyaluronic acid levels in the skin gradually decline, reducing its ability to recover from repetitive muscle movement. Volume changes in the lower face can also make the crease more pronounced. However, the rate of change varies considerably between individuals and is influenced by genetics, sun exposure, lifestyle, and skin type. Not everyone will experience significant worsening, and some individuals may find the crease remains a subtle feature throughout their lives.

Are there non-injectable options for improving the mentalis crease?

Non-injectable approaches may include topical skincare — particularly products containing retinoids, peptides, or growth factors — which can support collagen production and improve skin quality over time. Energy-based devices such as radiofrequency or ultrasound treatments may also be discussed in some clinical settings as options for skin tightening. However, for a deep or established mentalis crease, non-injectable options alone are unlikely to achieve the same degree of visible change as injectable treatments in suitable candidates. A practitioner can help you understand which options may be realistic for your specific concern.

What questions should I ask during a consultation about the mentalis crease?

Useful questions to consider include: What is causing the crease in my case — muscle activity, volume loss, or skin quality? Which treatment approach, if any, would you recommend for my anatomy and why? What are the risks associated with that approach, and what are the alternatives? How long might results last, and what would ongoing maintenance involve? What would happen if I chose not to have any treatment? A good practitioner will welcome these questions and take time to answer them clearly, helping you make a fully informed decision without pressure.

The mentalis crease is a common and well-understood feature of lower facial ageing, driven by a combination of muscle activity, collagen and elastin loss, and volume depletion in the perioral region. For patients in London and beyond who are noticing this horizontal indentation below the lower lip, it is a natural and understandable area of interest — and one that aesthetic medicine can, in appropriate candidates, address with thoughtful, tailored treatment planning.

Understanding the anatomy, the underlying science, and the realistic scope of available treatment options is the most valuable first step. Non-surgical treatments including anti-wrinkle injections, dermal fillers, and skin quality therapies each have a potential role in addressing the mentalis crease, but none is universally suitable, and outcomes will always depend on individual factors assessed in person.

Maintaining good skin health through daily sun protection, appropriate skincare, and healthy lifestyle habits remains important for everyone — whether or not aesthetic treatment is pursued.

Treatment suitability, risks, and expected outcomes should always be assessed individually during a professional consultation.

If you have concerns about the mentalis crease or the appearance of your lower face and would like to explore your options in a calm and informed clinical environment, speaking with a qualified aesthetic practitioner is the appropriate and recommended next step.