Hello, 35 here. I have gotten almost full correction of my nasolabial folds/lines, which were quite pronounced. We used Juvederm. However, my injector said that one side where the line/indentation extends really right up to the corner of nose is not correctable. She said she does not wan to inject there because it could burst a blood vessel and cause that area to become seriously discolored. Is it truly a bad idea to fill this area, or should I seek a 2nd opinion? Thanks ever so much, ~Cindy
Uncorrectable Nasolabial Folds? (photo)
Doctor Answers (14)
Filling the nasolabial folds
The naslolabial fold is a natural feature for most people. Filling it completely is not necessarily a good idea as this does not tend to make us look younger. Softening the nasolabial fold can be helpful but it is imperative to pay attention to the overall facial contour and volume as well as the facial appearance with animation such as smiling, talking, etc. Filling the area in question is not a "bad idea", you should explore with your doctor whether this is important to your overall facial appearance.
Filler to correct nasolabial fold
I agree with Dr. Steil when she says that this area is not meant to be flat. However, if this line really bothers you it can be corrected with careful well placed injections. The problem here is not that the area is highly vascular. the problem is that there is an artery under that area that if occluded will cause necrosis of the skin there. Your doctor must be careful and not put so much firm filler over that artery or it can be compressed and tissue destroyed. there is more than one way that this can be corrected and I think that deep injection or superficial can help if done correctly with the right materials.
Correcting the nasolabial fold
I think that your doctor did a good job of correcting your fold as I don't see anything left to inject.
I don't like the signs of "getting older" either, but don't forget having a nasolabial fold is normal. Look at your pictures from childhood, and look at children's faces. Everyone should have a nasolabial fold near the nose.
Yes, the fold will become more prominent as you age- so yes, keep your face lifted. But keep it natural!
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Nasolabial folds and correction with hyaluronic acid fillers
An experienced injector should quite easily be able to inject the region you mention. There are ways to prevent embolization.
However there is an aesthetic concern with trying to fix the nasolabial folds completely. The corners of the mouth can be distorted downwards in an odd fashion, restricting upward motion of the smile as well. You don't want to win the battle but lose the war!
In many patients who frequently get hyaluronic acid fillers it we use autologous fat-fascial grafts to achieve a more permanent result.
Web reference: http://drbrent.com/signature/livefill/
Juvederm for naso-labial folds
Thank you for your question and photo.
Nasal alae triangle is highly vascularised area and potentially can cause vascular occlusion -that is true, but careful injection with constant checking that not hit a blood vessel normally should be possible.
Deeper bolus placement also can help support layered deposits of more superficially placed dermal filler and give good volume replacement for this deep tissue atrophy defect. I would advise to see a more experienced doctor, but make sure that the dermal filler you had was actually Juvederm.
Nasolabial Fold Filling at Nasal Junction
The nasolabial fold can be filled at the nasal junction if you want. Some plastic surgeons might argue that this is the best place to put the filler. Others would argue the opposite.
I generally do not treat high up near the nose for similar reasons. To much product in that area can compress on important blood vessels, and is not worth the possibility of cosmetic enhancement. Sometimes building the lateral cheeks pulls the NLFs up and can improve their appearance in a more natural way, as it is fat loss and descent in your cheek compartments that contribute largely to the prominence of your NLFs. I would see a board-certified dermatologist or plastic surgeon for their opinion on volumizing your cheeks as a treatment option. Good luck.
Uncorrectable nasolabial folds
I believe in the hands of a highly trained and experienced injector such as a dermatologist or plastic surgeon, you should be able to improve the nasolabial fold, while still avoiding necrosis by intravascular injection of filler into an underlying artery. That said, your aim should be a great natural look, not perfection since that is incredibly hard to achieve and can result in other problems or an unnatural look.
Nasolabial fold correction
As stated, the superior portion of the nasolabial crease, next to the nose, should retain some definition. However, it does not make it untouchable. In fact, this area responds quite well to dermal fillers. When an injector uses Juvederm or other HA fillers and follows the product insert instructions for placement, there shouldn't be a problem. The adverse side effects are typically seen with inexperienced injectors working outside their skill set. Seek out an experienced injector that can show you before and after pictures of their own work. Also it is not unreasonable to inquire about training and how often they inject. Experience and education does matter when it comes to good versus great outcomes.
Thanks for sharing.
The photo you submitted looks like a great result. Sometimes the enemy of good is perfection, but it's ok to get a second opinion. Good luck. Dr. Aldo.
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.
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