Deep smile lines: Filler up please!

Smile lines (nasolabial folds) are a natural consequence of facial movement - particularly the most pleasant animation, smiling.

The changes that occur under the skin and within the skin result from numerous factors. These factors include the condition and/or thickness of the dermis (deep layer of skin), the epidermis (superficial layer of skin), and the subcutaneous tissue (layers of fat, muscle and connective tissue under the skin). The compound effects of repetitive folding of the skin during facial animation, photodamage, and aging of the skin and subcutaneous tissues result in a deepening of the nasolabial folds, and a thinning of the dermis and epidermis.

Historically, the lines were excised surgically, placing the scar within the natural position of the folds for camouflage - sounds pretty drastic, but results were acceptable greater forty years ago. The recent concepts of treatment involve filling of the defect or depressed area with injectable fillers that can be employed in the office setting.

The choices of the fillers in order of longevity are:

1. Collagen
2. Hyaluronic acid (HA)
3. Calcium hydroxyapatite (CaHA)
4. Polymethyl-methacrylate (PMMA)
5. Fat graft

In my practice, I commonly use CaHA (Radiesse) for the treatment of deep lines. I have found that the results look natural, are safe, and tend to be long lasting in my patients. There has also been evidence showing a thickening of the dermis layer of the skin resulting from collagen production stimulated by the CaHA.

HA (common forms: Restylane and Juvederm) are also great for the treatment of nasolabial folds. Theoretically, they do not last as long, however variations exist between patients and the longevity of these products. Some of my colleagues who have used HA exclusively have observed that different injection techniques may result in longer-lasting results.

Fat is also a wonderful option for nasolabial fold filling. Generally, it is more expensive and labor-intensive, as fat has to be "grafted" (moved from one part of the body to another) using liposuction technique. Evidence also exists that fat grafting may also transfer stem cells that may result in favorable effects on the dermis and epidermis. The tricky part of fat grafting is interpersonal variablility in the success of the fat relocation.

Laughter is the best medicine, but expressing joy can cause lines to form around mouth. Luckily, you don't have live with it. These are some tips to keep creases away and make skin look smoother and younger

Why wrinkles form

1. Decreased volume

Over time, skin loses fat, collagen and hyaluronic acid. As a result, mature skin is thinner and drier than young skin.

"Like a raisin," says Beverly Hills facial plastic surgeon Dr. Simoni, "when skin loses volume, you'll see wrinkle on the surface."

·          Treatment: The easiest approach is to apply moisturizer to temporarily rehydrate (and plump up) the skin. However this is more preventative than a cure.  That is why a lot of creams that promise wrinkle treatment do not always work.

2. Loss of elasticity

As skin ages, the collagen and elastin fibers in the dermis break down, reducing skin's ability to "snap back" from smiles and other facial expressions. Exposure to sunlight accelerates this process.

Treatment: Wear broad-spectrum sun-block and apply an antioxidant cream like vitamin C daily.

3. Excessive motion

Dynamic movements that cause the skin to repeatedly crease in the same place, such as smiling, will wear down the underlying tissue creating a wrinkle or crease.

Treatment

·          Botox would relax underlying muscles decreasing the crunch on the skin.  Dr Simoni does not recommend botox arround the mouth.

Downtime: Virtually none, but slight swelling (that looks like a welt) may last a few hours following the injection.

Risks: Drooping of the eyelid or brow (rare)

·          Injectable fillers

Hyaluronic acid fillers (like Restylane or Juvaderm) can be injected directly into wrinkles to restore volume loss. For the fold Dr Simoni recommends Radiesse lasts longer than restylane or Juvaderm.

Downtime: Swelling can last 1--2 days; some slight redness.

Risks: Bumpiness and bruising