Received one syringe Juvederm Ultra XC couple hours ago for laugh lines but still see wrinkle indentation line. (Photo)

Indentation is more prominent on left side. He injected then massaged it. I can still see the wrinkle line. If I touch it I feel some of the product but it might be swelling. Seems he didn't inject direct into "wrinkle indent" but about a centimeter over/above from it. I wanted that indent filled out. He made comment before starting that my cheeks were "hollowing out". Maybe he wanted to fill the "hollow" instead of actual wrinkle line? Maybe it will settle better in few days I'm hoping.

Doctor Answers 5

Laugh Lines and Juvederm

It appears that the problem is that only your "laugh lines" were addressed.  I would prefer to see your cheeks lifted away from the nasolabial area with Juvederm Voluma.  Please consult an expert in cosmetic injections.  Best, Dr. Green

Fillers in NLF's

Fillers placed in the nasolabial folds will soften the crease, but will not efface the fine line.  Best of luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Improving Laugh Lines Generally Requires Non-Surgical Cheek Augmentation With Volumizing Fillers.

Your question actually raises some very interesting issues that should have been addressed with you in detail by your physician BEFORE treatment to avoid the obvious disappointment and concern that you are experiencing right now.

I think a quote from an article in the recent February, 2016 issue of one of our trade journals, Practical Dermatology, would be extremely helpful in addressing and clarifying your present circumstances: 

"The way we use our fillers is very revolutionary compared to what it used to be. It's not just about filling in fine lines. We're revolumizing the face. We're lifting in certain areas...Nonsurgical approaches can create a similar effect to a facelift." 

From your photos, there appears to be visible volume loss in the mid-facial region, a problem that typically leads to increased prominence of the smile (laugh lines). In the hands of experienced injectors, the cheek and the smile line problem would be addressed by the use of a volumizing filler, such as Voluma XC, placed in the cheeks (not directly into the smile lines themselves). This would not only improve and rejuvenate the entire cheek contour, but would secondarily provide sufficient lift to straighten the smile lines without the need for directly injecting them. Juvederm Ultra XC, which is less robust a filler, would not be my first choice for this approach, nor would one cc ordinarily be sufficient to do the job properly.

Now, if you are only concerned with the fine lines in the smile line region (i.e. the etched-in creases resulting from years of hundreds of times per day smiling, laughing, etc., then the use of superficial filler, such as Belotero Balance that has little to no tendency to engender the unwanted, bluish Tyndall Effect when injected superficially within the skin, would have been the more appropriate choice. It also possesses less of a potential for causing swelling of the tissues due to water retention than do the Juvederm products. 

For now, it is probably best to wait a couple of weeks to allow for any injection-related swelling to dissipate before revisiting how best to proceed. Good luck to you.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.8 out of 5 stars 24 reviews

Results after Juvederm

Dear Romina0523,

It is typically to feel some "lumps and bumps" a few hours after the injection at the site. These soften over the next week or so. In addition, the product continues to absorb water over the next week as well, and you may notice that your lines fill out more after that time. If you are still unhappy with the results in 2 weeks, you could return to the office to have some additional filler placed.

Received one syringe Juvederm Ultra XC couple hours ago for laugh lines but still see wrinkle indentation line.

Thank you for your question and for sharing your photographs.  After filler placement it often takes between 1-2 weeks for the results to settle, soften, and have their full effects.  One syringe is often needed per laugh line so depending on your result you may require more filler to improve the appearance of the indentation line.   I do agree that you are experiencing some cheek descent which is contributing to your laugh line appearance and filler placement into the cheek to add volume and support will likely improve your laugh line results.  Hope this helps. 

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 43 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.