How can I treat deep smile lines?

Smile lines, or nasolabial folds, are present even in children. As we age and loose volume in the cheeks and mid-face, they become more prominent. Restoring the apple of the cheek is one way to soften nasolabial folds. This can be done with a temporary filler such as Radiesse or a more permanent treatment with fat injections. Another option is to treat the line or fold itself. I prefer hyaluronic acid fillers for this area, such as Juvederm, Restylane and Perlane.

Smile lines or peri-oral lines are some of the most challenging to treat on the face.  There are several options depending on the amount of result you want, the money you want to spend and downtime you are undergo.  Lasers Probably the most effective treatment is CO2 laser. The fractionated version (Active FX and Deep FX) are a nice combination of very good results while limiting downtime.  This procedure uses a laser to remove the damaged skin and heat to stimulate skin repair and new collagen growth.  Procedures run around $3000-$4500, count on downtime of about 1-2 weeks but the results will be very good for a single treatment and will likely last several years.  Dermal Fillers Another option is a filler like Juvederm.  Depending on the amount of Juvederm is needed, you may spend anywhere from $500-$1500.  If injections are done with proper anesthesia, they are almost completely painless.  Swelling will likely last  from a few days up to a week and results will last about 6-9 month.

Smile lines, also called Nasolabial folds, can be treated with a number of different products. Hyaluronic acid fillers: Restylane, Juvederm, and Perlane The most popular products (in the USA) in the Hyaluronic Acid family include Restylane, Juvederm, and  Perlane. These fillers are injected underneath the smile lines. The goal is to correct the contour of the skin (the deep folds) and make them more shallow. Just by changing the shape of the grooves,  from a "V" shape to a "U" shape, you will have less of a shadow which will reduce the appearance of the smile lines. Fractional resurfacing lasers Many times, there is a crease or wrinkle at the bottom of the nasolabial fold. Although the fillers may make this wrinkle or crease look a little better, the fillers are not intended to make it go away. If the injector tries to make this wrinkle or crease disappear by injecting the filler directly underneath the crease, the material may leave a bluish discoloration (called the Tyndall effect). A much better way to treat this crease would be to use a fractional resurfacing laser. My favorite fractional resurfacing laser is the Lux 2940 made by Palomar Medical. Radiesse Another option for treating the smile lines is a product called Radiesse. Radiesse does not contain Hyaluronic Acid. Instead it contains a very fine powder called calcium hydroxylapatite (CaHA). This powder stimulates the production of collagen. As the gel carrier that holds the CaHA dissolves, it is partially replaced by your own collagen. This new collagen may last for years. That is why some injectors call Radiesse a semi-permanent filler. The first treatment with Radiesse may last for about 3-6 months. The second treatment may last between 12 and 18 months. With each treatment, you are adding more of the CaHA which will stimulate more of your own collagen. One advantage of Radiesse is that it comes in a slightly larger syringe (1.3 cc vs 1.0 cc for Restylane and 0.8 cc for Juvederm). One disadvantage of Radiesse is that we do not have any chemicals to dissolve it. Going to an experienced injector should minimize the risk of any problems. You should also be aware that these same fillers can be used to enhance other areas such as the hands, hide bumps on the nose and enhance cheek bones. Michael Sinclair, MD