Keep on Smiling - How to Treat Smile Lines

It has been said that the best form of plastic surgery is smiling, so by all means keep on smiling.

Smile lines are usually the result of the loss of volume in the face that occurs along with the aging process. I believe that replacement of your facial volume is the best treatment for smile lines (naso-labial folds).

Radiesse, used to build up the submalar (cheek) area, is excellent at restoring volume to the face in a safe and dependable fashion when injected by an experienced physician. It should last for 12-18 months.

For those who desire a long term correction, fat transfer to the face is best (again, find an experienced physician with an aesthetic sense). When performed properly, fat transfer has been shown to be permanent.

Midface implants can restore volume, but appear unnatural to me. I am shy of Sculptra because of serious adverse granuloma reactions that I have seen from other physicians. Once the volume is restored, then the superficial facial fillers can be used to complete the treatment.

It has also been said that when you laugh the world laughs with you; but when you cry, you cry alone. So keep on laughing and smiling :-)

Be well.
Dr. P

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.

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Patients are choosing less invasive options for correction of nasolabial (smile or laugh lines) folds.  The options are numerious and include Radiesse, Juvederm, Restylane, Perlane, and Fat Grafting.  Plastic surgeons and dermatologists each have their preferences so a full discussion should be made with your practitioner.

Your discussion should focus on the risks of each particular filler, method of injection, technique of injection, quantity of injection, and postprocedural follow-up.

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