If Juvederm Didn't Work on my Smile Lines, What Are Some Good Alternatives? (photo)

Based on your picture, your smile lines are partly the result of your cheek falling down.  If you added filler (eg juvederm ultra plus, perlane, radiesse) to the cheeks, that would soften your smile lines and bring the focal point of your face upward.  You can then add additional filler to the smile lines, if needed.  Sometimes several syringes are needed to obtain full correction. 

Adequately treating furrows, deep wrinkles, sagging and jowls these days doesn't necessarily boil down to the question of whether one or more additional vials of volumizing fillers will do the job. In my experience, the best approach takes into account the individual's particular problems from the standpoint of whether they need to be addressed by vectoring, volumizing, or filling. For fine wrinkles, we have fillers and for deeper furrows and volume loss, we have developed volumizing injectable fillers. More recently, for sagging skin and apparent laxity, we have "The Nonsurgical 3D Vectoring Lift."

A vector describes a magnitude and direction of force. Aging skin is characterized by a negative downward and inward vector of sagging. To counter this, surgeons traditionally pulled skin upward and outward--i.e. using a positive vector. The key difference between the outcomes of traditional surgical correction and nonsurgical 3D vectoring, both of which lift upwards and outwards, is the Nonsurgical 3D Vectoring Lift's additional corrective dimension of ‘forward projection’. This 3D effect is the result of volumizing with the use of injectable agents designed for this purpose, such as Radiesse, Voluma, Restylane SQ, and Stylage XXL.

The Nonsurgical 3D Vectoring Lift is predicated upon the fact that the face and portions of the neck differ in their degree of mobility. The region directly in front and behind the ears is a fixed, denser, relatively immobile area, in contrast to the mid-cheek region (hence the greater tendency of this region to sag with the passage of time). These anatomical differences are exploited in the Nonsurgical 3D Vectoring Lift by making the fixed areas serve as anchoring points for the mobile tissues. 

In determining the positive vectors for the mid to lower face, the tissues that require lifting are identified by pulling the skin directly in front of the ears in a direction perpendicular to the area that requires correction. If the pulling results in lifting of the desired tissue, then the vector has been correctly identified and is then marked in accordance with 3D vectoring protocol. A similar approach is used in the region of the angle of the jaw or in back of the ear when dealing with neck laxity.

Once the proper vectors are marked, the volumizing agents are injected in a series of radiating bands that serve as support struts to the skin and that impart the necessary 3D outward projection--the lift--that distinguishes and defines this nonsurgical approach. The high viscosity and elasticity of the volumizing fillers serves to hold and re-support the overlying tissue and restore more youthful contours.

Although volumizing fillers are reabsorbed over time, they do promote new, native collagen synthesis, which may continue to provide structure, firmness and improved skin quality while continuing to lift tissues. A typical Nonsurgical 3D Vectoring Lift of the face takes about fifteen minutes to perform. Bruising and swelling tend to be minimal, and most people can return to work or social activities immediately following treatment.

So, the short answer is that the addition of one or more vials of material may not be the answer, changing the treatment approach by vectoring first might very well be.

Thank you for the question and your picture. For some patients, the hyaluronic acid fillers (HAs, including Juvederm, Belotero, and Restylane) don't last very long. This can be a quirk in your metabolism -- your body gets rid of the product much faster than average. In these rare cases, I recommend to my patients that we try a different type of filler. For the nasolabial folds, Radiesse is a great option. This is a different type of molecule (cacium hydroxyapatite) and should last longer.  Another option, typically in patients a bit older than you, would be fat grafting. This procedure can provide long-term results in many cases.