43, my nasolabial lines have gotten very prominent with horizontal indentations starting around the corner of my mouth. (Photos)

I had a consultation with an RN at the medispa associated with my dermatologist's practice. It was recommended that I get 1 ml of Juvederm XC Ultra Plus and 1 ml of Juvederm XC Ultra in the area around my mouth and chin. I have never had an injectable treatment before. Should I be concerned that it is not an MD performing the injection? I'd like to take some action now to minimize the appearance and also prevent further signs of aging. I don't have many fine lines or wrinkles except my mouth.

Doctor Answers 11

42 Year Old with Prominent Nasolabial Folds

Thank you for posting your photos with your interesting dilemma. It appears that you have some early signs of facial aging due to loss and remodeling of your facial bones. Fortunately, there are many options available to you if you choose the best injector. The best injectors are confident, can analyze your face and determine which fillers to use and the best techniques to give you the natural and beautiful results that you desire. As you loose the bone support in the face, the cheeks begin to sag and the nasolabial folds around your mouth deepen. As the chin recedes slowly, loss of volume manifested as depressions around the chin and mouth appear. This is why it is more apparent in thinner and more fit people after 40 years old. I prefer to think of fillers as a restoration, not simply filling the face and creating the "chipmunk" cheeks. Restoring natural contours produces the best results. Products like Voluma, Radiesse and Sculptra will give you the optimal and most natural correction. I recommend that you have a consultation with a Board Certified Plastic Surgeon who is knowledgeable of facial aging, experienced with these fillers and consistently produces natural results. At the time of your consultation, please bring a photograph of yourself from a few years ago for comparison. Best wishes, Dr. Richard Swift

New York Plastic Surgeon
5.0 out of 5 stars 23 reviews

Can a nurse inject filler around my mouth

This is a controversial subject and is somewhat regulated by state laws regarding the scope of practice of licensed professionals.  Regardless the essential thing is to know the experience of the injector, their training and prior outcomes.  Ultimately the overseeing physician is responsible.  The area you need filling is very correctable with Juvederm and patients are usually very satisfied with the results.  The most common complication is bruising.

Stephen Mandy, MD
Miami Dermatologic Surgeon
4.3 out of 5 stars 6 reviews


If it were me I would want an experienced physician injecting my filler. I think if you are looking for a subtle softening of those lines  I think that you can get that from fillers.  Fillers are only going to fill that area and improve the appearance for 9-12 month.  If you are looking to further prevent signs of aging I would look into additional treatments aimed at skin tightening and resurfacing.  Good luck with your treatments.

Michelle Ellern, DO
Livingston Physician
5.0 out of 5 stars 3 reviews

43, my nasolabial lines have gotten very prominent with horizontal indentations starting around the corner of my mouth.

Hi there, I feel strongly that you should see a board certified dermatologist with plenty of experience doing injectables. I would not recommend a spa injector or a nurse injector. I have been injecting fillers since 1994. Typically, there are very few side effects..swelling and bruising mainly. However, I can not stress enough that each face is different and if there are side effects you want someone with experience for your face. I do agree with you that your instinct is correct. Go to the best and demand the best. 
Good luck,
Dr. Downie

Jeanine B. Downie, MD
Montclair Dermatologic Surgeon
5.0 out of 5 stars 3 reviews


Many practices have nurse injectors who do a wonderful job.  If the injector is experienced and works closely with the doctor then you should not have any issues.  You can ask to see before and after photos to get an idea if you like the results of other patients.  

Camille Cash, MD
Houston Plastic Surgeon
4.8 out of 5 stars 33 reviews


I prefer to inject all my patients personally.  Some doctors prefer that their nurse or other staff perform the procedure and many can do an adequate job.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Filler injection strategy

If you were my patient, I would recommend starting with Juvederm Voluma XC in the Zygoma/cheeks, and the pyriform areas. Midface filler placed strategically will lift and efface the upper nasolabial fold. Then you will need less in the lower portion of the nasolabial fold. In your photos, I can see that the cheek volume has descended. Another thought is tightening of the skin and improvement of skin quality which helps the creases, pores, and sun damage with non-invasive techniques, i.e. - OPL CynoSure Icon MaxG, and MiXto CO2 Laser Resurfacing. All modalities can be done very comfortably in an office setting - even on the same day with minimal social down time for the CO2 Laser (OPL and fillers - no down time!). Technically, you can have a non-physician do these things, but do they have aesthetic judgment, deeper knowledge of the facial anatomy, and the capability of keeping you comfortable. Might be worthwhile to seek an MD opinion. Many offices offer package pricing for combination treatments which will give you more "mileage" on your dollars. Best wishes with your decision.

Sara A. Kaltreider, MD
Charlottesville Oculoplastic Surgeon
5.0 out of 5 stars 7 reviews

Juvederm around mouth for NLF

I think the recommendations are correct. If the injector is experienced, this area is not difficult to inject and results should be good. If you want the doctor to do it, sometimes this means a higher pricing. I would express you concerns to you provider.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.7 out of 5 stars 41 reviews

43, My Nasolabial Lines Have Gotten Very Prominent With Horizontal Indentations Starting Around The Corner Of My Mouth.

Thank you for your excellent question and for sharing your photographs.  Based on your photos, you appear to be an excellent candidate for a hyaluronic acid based dermal filler such as Juvederm to treat your nasolabial folds and the area around your mouth and chin.  Beautiful and natural results can be achieved.  Please be sure to see an expert injector for an in-person consultation to fully discuss your goals and expectations in order to determine the best treatment plan.  Hope this helps and best wishes! 

Christian N. Ford, MD
Cohasset Physician
5.0 out of 5 stars 31 reviews

Get an MD's opinion

It is likely that one syringe of filler would suffice to correct the area that concerns you, especially since you are slim by what I can see in the picture. Also,  you woyld benefit from IPL/BBL photorejuvenation. Current rejuvenation trends are less about filling one  line or a few creases and more about considering the overall contours, skin health and the balance of each patient's features and needs. Rejuvenation has changed over time. Bring a high school photo to your consultation and think about what you'd like to accomplish as you start down this exciting path. 

Elba Pacheco, MD
Annapolis Oculoplastic Surgeon
4.2 out of 5 stars 6 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.