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it is worth emphasizing that these days we no longer "chase" wrinkles and folds by injecting directly under them--an outdated approach that we used thirty years ago.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.
