Fillers didn't work on not too deep nasolabial folds because of adhesions, now what? (photo)

Question

fillers do not work on my nasolabial folds adhesions but get pushed out making it worse. what can bedone for these adhesions so that i can put filler there? do you think filler made it worse? need help figuring out as if i put filler more i will waste money and look even worse.

Nelson Lee Novick, MD · Answer

When an indentation or a fold is present that is believed to be held down underneath by adhesions (thick scar tissue), as in the case of scars (acne scars, chicken pox scars, etc.), then subcision followed by the injection of a volumizing filler to help raise the scar would be a viable alternative. Subcision is a simple, five minute procedure, in which a sharp needle or trochar is inserted below the scar or fold to break up and release the adhesion bands that are tethering the surface down. Once these are freed up, the injection of the volumizing filler can more easily lift the depressed surface upward in order to smooth the surface of the defect with the surrounding normal tissue. That having been said, it is worth emphasizing that these days we no longer "chase" wrinkles and folds by injecting directly under them--an outdated approach that we used thirty years ago. We are no longer interested in creating the so-called  "simian" face, i.e. the smile-line-less face found in apes and monkeys. Today, in a more sophisticated approach, we attempt to contour the face with the understanding that contour changes in one part of the face, for example in the lateral cheek (nonsurgical cheek augmentation) or the mid cheek (nonsurgical midface rejuvenation) can have profound secondary beneficial effects upon other areas of the face, including the nasolabial folds and marionette lines. For more information on any of the above procedures, check out the archives or Realself.com and it would be wise to consult a board certified aesthetic physician with experience and expertise in the use of these more sophiticated approaches and who is fully proficient with all the available materials to do the job right. Make sure to ask to see befores and afters.

Jason Emer, MD · Answer

It is uncommon for me to treat NLFs directly anymore.  Most people benefit from facial contouring and lifting, such as adding volume to the middle and lateral cheeks to lift the folds or to use collagen stimulators like sculptra to soften but not remove the folds.  I suggest seeking the advice and treatment of a well trained cosmetic dermatologist or plastic surgeon.  Best, Dr. Emer.

Steven J. Pearlman, MD, FACS · Answer

Nasolabial folds are a natural part of facial expression. If you look at a 7 year old, they likely have deeper folds than you have, I tell this to all my patients. So, trying to smooth out folds that are from very strong muscles pulling on the facial skin all day long doesn't always work. In many patients, actually filling the cheeks will restore a more youthful contour and make the nasolabial folds less of an issue. I call this "wow cheeks."

Joseph A. Eviatar, MD, FACS · Answer

It's difficult to evaluate a face from pictures but I always caution my patients away from focusing on naso-labial folds but rather on what brings out their facial beauty.  Many models and beautiful woman have these folds and many unattractive young people don't.  Fillers work, this is no question it's just a question of placement, type of filler and what will look best in your face.  It's about balance and proportion and making your face look terrific for YOU.  That is the conversation you should have with your doctor if you are not satisfied with the results of the filler and make sure you and your doctor examine oblique and side views of your face so you can really see what people see when they look at you.  We all tend to focus on lines and fold that we see in a 2 dimensional mirror and that is not necessarily the route to looking your best.  That being said, from the photos you present, it doesn't seem like your nasolabial folds are very prominent but it hard to tell.  See a board certified injection specialist for a consultation if you're not thrilled with your results.Best of luck!

Darryl J. Blinski, MD · Answer

Sorry to say in posted photos I see NO issue in your Nasolabial folds. Maybe in person opinions best for you in your case....

Fillers didn't work on not too deep nasolabial folds because of adhesions, now what? (photo)

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