For patients with deep smile lines, a variety of factors will determine the proper treatment approach. Younger patients with isolated smile lines or "nasolabial folds" most often benefit from an injectable filler. The most popular of these fillers are the hyaluronic acid (HA) products and their varients, such as Restylane, Juvederm, Prevelle, etc. In the nasolabial fold area, the cross-linked forms of these fillers (Perlane, Juvederm Ultra) are longer-lasting and generally preferred.
Patients who are somewhat older, or who have substantial signs of sun damage or loss of skin elasticity due to smoking or other environmental factors, or who have signs of facial atrophy, may benefit from autologous fat injections, or deeper fillers such as Sculptra or Radiesse, which are designed to augment the facial volume. Fat transfer involves a surgical procedure to harvest and prepare the fat for injection, and because of the size of the injecting needles required, usually necessitates sedation or general anesthesia. Sculptra (L-Polylactic Acid) and Radiesse (Calcium HydroxyApatite) are walk-in office treatments that do not require sedation or general anesthesia. Patients with significant fine wrinkles and sun damage in addition to deep nasolabial folds and smile lines may also benefit from laser resurfacing or chemical peel of the face.
Finally, patients with significant facial laxity in addition to a component of deep smile lines, are the best candidates for facial rejuvenation surgery. Face lift, either combined with autologous fat injections, or staged before or after fillers or resurfacing, can correct sagging neck, cheek, and jowl skin that cannot be corrected by any form of filler or resurfacing procedure in isolation.
Your plastic surgeon should be able to give you an honest opinion regarding which procedure is best for you, depending on the factors outlined above. In some cases, a simple paint and patch is all that is required, while in other cases, a more comprehensive surgical approach is required.
