Fillers made my nasolabial folds worse? Why? (photo)

Question

The lower part of my face needs the work. I had Voluma in my cheeks to fill them out but those deep folds and down turned mouth has got to go.As I said fillers made them worse. will Botox Help? Also the filler wasn't injected to well as you can see by the formulation of the bluish tinge of filler to close to the surface. It seems the fillers tends to migrate a little above the folds making them deeper. Will Botox Help with the corners of my mouth?

Kenneth D. Steinsapir, MD · Answer

It is less runny than Juvederm or Belotero.  However it is much more runny than Restylane and Perlane.  That means that once it is shoved into your face by your injector, it can move where it wants to.  If you are an injector who does not know how to control facial volume with filler, these "smooth" fillers migrate and "fix" lumps and bumps.  Unfortunately the shifting product causes its own problems.  You need to find an injector who does not drink the koolaid and uses high G prime fillers like Restylane and Perlane.

Andrew Campbell, MD · Answer

I'm sorry to hear that your folds are worse after filler. They shouldn't be. Botox can be used to help lift the corners of the mouth by relaxing the muscle that pulls the corner of the mouth downward. However, this won't help the visible folds much at all. You have the choice of more filler appropriately placed (you would need several syringes) and / or a deep plane facelift to lift the cheek. If you want to try to avoid surgery, see someone with extensive experience with fillers and you should get a very nice improvement in the nasolabial folds, you just need more volume.Andrew Campbell, M.D.
Facial Rejuvenation Specialist
Quintessa Aesthetic Centers

Jason Emer, MD · Answer

fillers can be used to improve deep lines and wrinkles and if you are unhapy they can be reversed in some instances if a hyaluronic acid filler was used.  See an expert in facial shaping. Best, Dr. Emer.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  Though carefully placed Botox may improve the corners of your mouth I would consider dissolving some of the filler material placed within your smile lines to remove the bluish hue and lumpiness seen.  I would then continue to invest in cheek fillers to regain some tissue lift before seeking additional correction into your smile lines.  Hope this helps.

Robert Deeb, MD · Answer

It is difficult to fully assess from the photos alone, but generally speaking, if filler is injected into the areas just next to the fold instead of the groove of the fold, it can make the fold look deeper. 
Another potential issue is if the product was injected too superficial (close to the surface of the skin ) which can also cause problems. 
I recommend seeing a board certified plastic surgeon, facial plastic surgeon or dermatologist to have the issues evaluated. Some of the filler can potentially be dissolved which may help correct things. 
Hope that helps and good luck.

Nicholas Lahar, MD · Answer

Meankitten, love the name!
The nasolabial fold is a natural crease in the face.  As we get older, our cheeks lose some volume and begin to droop.  But the cheek droop stops at the fold and will tend to "pour" over the fold since that is where the cheek has to stop!  If someone added volume to the cheek in the wrong scenario, that can actually enhance the fold, NOT what we want.  
If you can see the bluish tint and you feel that the folds have gotten worse, your injector can use a special enzyme that breaks up the filler, called hyaluronidase.  This should get rid of the filler but may take a few treatments.  You can assess your options from there.  I would recommend a board certified plastic surgeon or facial plastic surgeon.  They can give you a full spectrum of treatment options depending on your goals, your tolerance (or not) of surgery, downtime that works for your life, etc.
With regard to Botox for the corners of your mouth, it can be injected into the muscle that "downturns" the corner of the mouth.  This is a slightly more advanced injection technique, and I would recommend an expert injector (plastic surgeon, facial plastic surgeon, dermatologist, etc).  The same injector could also potentially use filler in this area.  Actually a combination of both Botox and Filler, when done correctly, can give you an even better result and longer lasting result than either alone.
Best of luck on achieving your goals!
Nicholas Lahar, MD

Marek Kacki, MD · Answer

Although we do not have before and after photo comparison, I trust that your perception is right and nasolabial folds appear to you to be worse than before the injection. The only possible way to have those folds become worse after cheek injection is if the filler, in your case Voluma, was injected in the wrong plane, too superficial, without "anchoring" to the bone. Injections into the superficial layer may add volume but, most importantly, they add weight to the soft tissue. Subjected to gravity, the further shift of the soft tissue downward will created visible deepening of the nasa-labial folds. Although Botox could help in this area in general, I would consider it a waste of money in your case. You may need to change the entire approach after being carefully evaluated by your Plastic Surgeon. Good luck!

Aurora DeJuliis, MD · Answer

Without looking at your picture before you had the Voluma injected it is difficult to make a good assessment. First of all before getting fillers on your face you want to make sure that the injector is a physician well trained with an artistic eye, since fillers are supposed to be injected in a way that can make your face refreshed. In your particular case Botox will not give you a tangible result. If the Voluma was injected into your nasalobial folds it needs to be removed. In my expertise I think you need more Voluma in your cheeks and 2 or 3 syringes of Juvederm in your mouth area.

Melvin Elson, MD · Answer

Botox can help lift the corners of the mouth and the correct plac ement of fillers can smooth out the nasolabial folds. Be sure you are seeing a board certified dermatologist and he is doing the inejctions

John S. Alspaugh, MD, FACS · Answer

Botox may be helpful in subtlely bringing up the corners of the mouth . A muscle acts to pull the corners of the mouth down, just like other muscles pull the corners of the mouth up in a smile. By weakening the downward pulling muscles, the corners of the mouth come up

Fillers made my nasolabial folds worse? Why? (photo)

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