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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

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.

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Facial sagging- facelift vs cheeklift vs fillers

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 103 reviews

Juvederm or Facelift

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. 

Nasolabial Folds - Filler vs. Midface Lift.

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, DDS, MD
Denver Facial Plastic Surgeon
5.0 out of 5 stars 56 reviews

Nasolabial and marionette lines, fillers or surgery?

Injectable fillers are great for softening the harshness of these lines, but as other colleagues have mentioned, they are limited to the extent of improvements.  Beware of the overfilled effects that can leave you with heavier cheeks and bigger jowls.  Your photo is helpful and you are more a candidate for a surgical lift as I believe you will be disappointed with fillers alone.

Randy Wong, MD
Honolulu Plastic Surgeon
5.0 out of 5 stars 20 reviews

Fillers or Face Lift

From the photos, your face has evidence of NLF's, Jowls with laxity of the skin and facial SMAS layer.  Fillers like Perlane, Juvederm, Radiesse or Restylane can fill in the NLF as well as the Marrionette Lines (in front of the Jowls)  and you will look better.  The fillers could also be used to fill out the front portion of your cheeks that appear flat.  Full, round cheeks make a woman's face appear soft, youthful and naturally attractive.

The question of whether, or not, you are a candidate for a Minimum incision Face Lift, traditional Face Lift or some variant is really a personal decision on your part.  At this particular moment, in time, how much time, money and effort are you interested in placing in improving your appearance?  If the loose skin, of your face, is a big priority at this point, then a Face Lift is warranted.  If you, on the other hand want to try fillers to see what they will do...this is also a great choice.  I think both options are good ones.

FYI, IMHO you will need fillers to the folds and cheeks even if you do a face Lift because facial beauty is dictated by the shape of the face, primarily the cheeks, no matter how tight...or loose the facial tissue become.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

Filler vs Mid-facelift

The descent of your skin after deflation from weight loss is quite common. A lot if the resultant folding at the mouth corners and naso-labial folds can be improved with fillers. This is, therefore, an excellent way to disguise the areas while you wait for your weight to stabilize. Once it has, the only real treatment is a Facelift, or Facelift and lower Blepharoplasty and cheek lift. This is because the problem is descent of the entire face, not just the central face.
 

Juvederm will not correct a lot of sagging.

Hi.

I am a big believer in fillers, but you have to know their limitations.  Going by your picture, you probably need surgery.  And a mid face lift alone will not correct the jowling.  You may need a more conventional face lift.

Fat injections can be done together with the face lift.  These give you more permanent upper cheek fullness.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Facelift

 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 12 reviews

Juvederm Vs. Midface Lift

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 48 reviews

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.