Filler for sagging, gaunt skin and deep nasolabial folds (27F) (Photos)

Question

I am 27. I have never been overweight. I have worn SPF 50 sunscreen daily since 19 and use been using tretinoin and a moisturizer every night for a few years. I don't drink or smoke, am active, and I eat a plant-based diet, but I have eaten sugary foods in the past. I had facial fat grafts, but the left side of my face did not retain the fat. I am so ashamed of my appearance and want to hide all the time. Would filler help at all? If so, where should it be placed (cheek/piriform fossa)?

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your background and photo. First, I want to acknowledge the care and commitment you’ve shown to your skin and overall health—daily SPF, tretinoin, and a healthy lifestyle are all powerful tools for long-term skin preservation.

Facial volume loss, especially in the midface and perioral areas, can certainly be distressing, and fat grafting doesn’t always yield symmetrical or lasting results. Based on your description and image, well-placed dermal fillers could be beneficial in softening the appearance of deep nasolabial folds and restoring midface volume.

Here are a few targeted suggestions:

Cheeks (malar and submalar region): Restoring volume here helps lift the midface and can indirectly reduce the prominence of nasolabial folds.

Piriform fossa: Filler in this area can soften the base of the nasolabial fold and provide subtle support to the area around the nose and mouth.

Preauricular and lateral cheek: May also be considered if the volume loss is more generalized.

That said, filler should always be approached conservatively and tailored to your unique anatomy and aesthetic goals. I recommend a consultation with a board-certified dermatologist or experienced injector who can assess your facial dynamics in person.

You are not alone in how you're feeling, and there are supportive, effective options available. We’re here to help you feel confident again in your own skin.

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. It sounds like you’re really taking care of your skin and health, which is great to hear. Given your situation, fillers could potentially help restore balance and improve the appearance of your face, especially on the side that didn't retain the fat from your graft. For your specific concerns, placing filler in the cheeks can help add volume and lift, creating a more symmetrical and youthful appearance. Additionally, targeting the piriform fossa (the area around the nasolabial folds) can help smooth out the transition between your cheeks and jawline, further enhancing overall harmony. I hope this helps and best of luck!

Camille Cash, MD · Answer

From the submitted photos it does appear that filler may help create more harmonious facial contours.  You can also consider Morpheus8 treatments that give a rejuvenated appearance by addressing tone and texture.  It sounds as if you have a skin care regimen in place, but it is a good idea to review it with an aesthetician to ensure the products are the correct ones for your skin type and concerns.

Narin Adem, MD · Answer

The best way to approach the early signs of aging and loss of volume is to try a little bit of improvement in the lateral check area with hyaluronic acid fillers. This would give support to the ligaments and lift the face. I would restrain from placing filler in the piriform fossa, because in the longterm it might not look as natural. In your case, a little bit of support in the marionette area would also be beneficial. In addition to that, I will definitely recommend you to also try rejuvenating device procedures, such as laser resurfacing, or micro-needling, combined with RF to improve the texture of the skin and stimulate collagen.  I recommend getting a formal evaluation with an expert. Best, Dr. Adem

Filler for sagging, gaunt skin and deep nasolabial folds (27F) (Photos)

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