Ask a doctor

Juvederm Injection vs Midface Lift

I'm in my 30's. I would like the nasolabial folds and mouth corners lifted as they are drooping.. (FYI, I've lost 20 pounds in 2 months). Do you think fillers can fix my problem? or I need a midface lift?

Doctor Answers (26)

Juvederm for Naso-Labial Line Problems vs. Mid Facelift

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I think Juvederm and possibly a mild pre-auricular facelift would work best to solve the naso-labial line problem. I am not a fan of mid facelifts as them tend not to last very long and can look unnatural if too much pull is used to alleviate the naso-labial line problem.

Nasolabial Folds - Filler vs. Midface Lift.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Dear Hanna19:  This is an excellent question.  In order to achieve the best possible outcome in rejuvenating the midface, it is best to first carefully analyze the face and determine the main cause of aging.  From your photo, it is somewhat hard to tell but it would appear that the main issue is descent of the midface tissues and therefore the ideal result will be with a surgical repositioning procedure such as a midface lift.  Although fillers will give some some degree of lifting as a byproduct of their revolumization effect, the degree of lift will be minor at best.

For simplicity sake, I prefer to categorize the causes of facial aging into 3 basic groups known as the 

3 D's of Facial Aging:

  1.  Deterioration of the skin surface.  As we age, the skin gradually transitions from a smooth, evenly colored, translucent surface to a coarse, unevenly colored (brown and red spots), wrinkled surface.
  2. Deflation or loss of volume.  The face can be thought of as consisting of 4 layers:  a) skin, b) fat (subcutaneous layer), c) muscle and d) bone.  Over time, the tissues atrophy (shrink or deflate) and we loose volume.  Shrinkage occurs in all layers but is especially evident in the fat layer.  The effects of deflation are particularly visible in the cheeks where people go from the full cheeks of youth to the haggard, deflated cheeks of the elderly.  Deflation also contributes to surface wrinkling.  This can be thought of in terms of the process whereby a grape turns into a raising. 
  3. Descent of downward movement of facial tissues under the effects of gravity.  As we age, the facial tissues weaken, become less elastic and unable to resist the constant pull of gravity.  This is especially true for the so-called retaining ligaments of the face.  the retaining ligaments are deep fibrous bands that attach the SMAS layer and skin to the fixed structures of the face such as the zygoma (cheekbone), parotid fascia and mandible (lower jaw).  What does this translate to in the face?  Droopy brows and eyelids, lower eyelid bags, malar grooves and nasolabial folds, jowls and turkey necks!

In order to achieve the best possible outcome and in order to determine how to best spend one's money it behooves the patient and the doctor to determine the exact role that each of the 3 D's of Aging are contributing to the facial aging appearance.  Only then, can one decide what the ideal treatment to obtain the most rejuvenation for your dollar is.  All of the facial rejuvenation procedures can be grouped into one of the

The 3 R's of Facial Rejuvenation:

  1. Resurfacing.  These treatments are targeted at reversing the changes that have occurred on the skin surface and include:  microdermabrasion, hydrafacial, chemical peels, intense pulsed light (IPL), fractional laser treatments, etc.
  2. Revolumization.  These treatments refer to those that aim to restore lost facial volume and include:  injectable fillers (hyaluronic acid, hydroxyapatite, poly-lactic acid, polymethylmethacrylate), fat transfer, and implants (porous polyethylene, silastic). 
  3. Repositioning.  These treatments are surgical in nature.  They include things such as Forehead-brow lifting, blepharoplasty (eyelid rejuvenation surgery), isolated midface lifts, face-neck lift and isolated submentoplasty. 

Getting back to your situation and your main concern, the midface and the nasolabial folds in particular.  The nasolabial folds deepen over time as the result of several factors.  The main factor is descent of the cheeks which allows the cheek fat to overhang the tight skin of the lip.  Also contributing to the nasolabial folds is the constant pull of the lip into the cheeks by the smiling muscles.  Over many years, as tissues deflate and weaken, the nasolabial folds become a permanent crease.  Rejuvenation in your case would be best served by a combination of both a midface lift to reposition the sagging cheeks and injectable fillers to revolumize both the cheeks and the nasolabial grooves.  In my opinion, the ideal filler would be using sculptural micro fat transfer, especially if you go ahead and have a surgical midface lift.  

Injectable fillers such as Juvederm, Radiesse, etc. will provide temporary relief.  Bear in mind, however, that typically these agents last about 1 year and their cost tends to add up quickly.  If the situation is begging for surgical repositioning, then injectable fillers provide only a short-lived camouflage and come nowhere near the results that surgical lifting can attain.  It is probably best to save up for the proper treatment in these situations. 

Good Luck, Mario J. Imola, MD, DDS.

Mario J. Imola, MD, DDS
Denver Facial Plastic Surgeon
5.0 out of 5 stars 52 reviews

Facial sagging- facelift vs cheeklift vs fillers

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Fillers help a bit to fill in wrinkles, to a point.

Midface and cheeklifts help to elevate the cheeks.

From your picture, you would most benefit from a facelift along with a cheeklift, maybe not the answer you were looking for, but that is what would be your most effective option.

The other procedures will also help, just not be as dramatic.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 100 reviews

Juvederm vs. Mid-Facelift

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Obviously, if you are in your 30’s you usually would not benefit from a mid-facelift. A mid-facelift has significant downtime and more morbidity in the periocular area and does not justify its use, in most cases. If you’re in your 30’s, the use of fillers in the fat compartments in conjunction with Botox will help you reshape and contour your face.

Rod J. Rohrich, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 20 reviews

Juvederm Injection vs Midface Lift

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

At your age you should try injection of Juvederm or Restylane if your main concern is the folds.  If you want fuller, more lifted cheeks you should consider fat grafting

Sam Naficy, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 150 reviews


{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

 I would first try the filler. Juvederm is a good option as is Radiesse.  If this is not enough, see a Board Certified Plastic Surgeon for a consultation.

Vivek Bansal, MD
Danville Plastic Surgeon
5.0 out of 5 stars 10 reviews

Juvederm or Facelift

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I see many patients that come in wanting Juvederm or Restylane to correct lines and wrinkles, when often they would benefit more from a surgical rejuvenation.

As we get "less young" our face (and the rest of our body) undergoes changes. Part of the change is a laxity in the skin and soft tissues, while part of the change involves a deflation or thinning of the soft tissues. 

Recent trends in surgical rejuvenation involve not only removing excess skin, but re-suspending the deeper soft tissues, instead of tightening and cutting them out, as used to be done. Other recent trends involve a much shorter scar that doesn't extend into the hairline of the back of the head. 

Juvederm is very good in improving deep lines around the nose and mouth in individuals who have good skin tone and elasticity overall. When the skin of the face and neck begins to lose its elasticity (jowling) Juvederm will have less of an effect, and may look artificial. 

Juvederm Vs. Midface Lift

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

At age 30 I would recommend the non-invasive approach of Juvederm and possibly laser skin tightening. If yoiu are continuing to lose weight you should consider more gradual weight loss so the elasticity of your skin will not be dramatically affected.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 45 reviews

You will need a Facelift to lift the corners of your mouth plus a filler like Perlane or Radiesse to improve the NL folds

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Filler injections alone will not lift the corners of your mouth. Perlane and Radiesse can plump the cheek and improve the Nasal Labial Folds.

A Facelift can lift the corners of your mouth and will help tighten the face especially after weight loss has caused the facial skin to sag.

Neither a Facelift or fillers will eliminate the Nasal Labial Folds as they are caused by the pull of the smile muscles which will continue to pull on the area after a Facelift or filler

Midface v. juvederm

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

since you are in your 30's and have recently lost 20lbs. i would favor fillers like radiesse for the folds and downturned corners of the mouth.  don't forget to lightly treat the prejowl area to de-emphasize your full cheeks. if you need more after fillers or further weight loss a cheek lift is always possible. good luck

Rafael C. Cabrera, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 1 review

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.