Fillers in nasolabial folds or cheeks? (Photo)

Question

I have an appointment for nasolabial Juvaderm injections tomorrow. However I now see recommendations mentioning fillers to the cheekbones that would produce a similar "lifting" effect. This was not an option offered to me when I had my consultation. Where are the fillers more beneficial, nasolabial folds or cheeks? I don't want to make the wrong decision and flaw my face even further...

Shanthala Shivananjappa, MD · Answer

Thank you for your question. Aging occurs differently with every individual. I suggest comparing a current photo of your face with an old photo in order to help your doctor better evaluate areas of volume loss. Overfilling your cheeks to lift the nasolabial fold may not suite everyone.

On the other hand, correcting the nasolabial fold first before correcting the mid face, the old fashioned way, can cause a simian look.

The second option to minimize nasolabial folds would be a skin tightening procedure, which can lift sagging skin. Once skin is lifted, you might need less fillers in the mid face. Consider these options with your physician.

Rukmini S. Rednam, MD, FACS · Answer

Hello Marie,Nasolabial injection can be very effective and help to blunt the lines that appear heavier as you age between the cheek and the lip/nose.  Cheek fillers such as Restylane Lyft and Voluma are a much thicker hyaluronic acids than the ones injected for nasolabial folds and works to elevate and define the cheek area with the added bonus of making your nasolabial folds less noticeable due to the elevation. In my practice, I have been offering this much more as the combination of cheek augmentation and reduced nasolabial folds really can refresh the appearance of your face.   From you photos this may be a nice option for you.  I would talk to your doctor prior to your injection about this other possibility if it interests you.    An experienced injector should be familiar with this option.  Best of Luck!Dr. Rednam

Paul Flashner, MD · Answer

Thank you for the question.  It is a critical question to be answered.  I almost never correct the naso-labial fold without doing a "lift" to the lateral cheek and restoring the volume in the mid-face.  When the cheek and mid face is appropriately addressed and corrected there is almost no need or much less need for filler in the naso-labial fold itself.  If your doctor did not mention this to you, I would definitely bring it up before you are actually treated.  If the cheek is not restored and lifted properly and the fold only injected directly it just makes the fold less prominent, but at the same time makes the area look fuller and is not the desired result or certainly not the optimum result.  Hope that helps.
Best,
Dr. Paul Flashner

Kian Karimi, MD, FACS · Answer

This is an excellent question. Different injectors have varying opinions on this matter. The reason you are noticing the nasolabial folds becoming more prominent is due to natural volume loss of the midface over time. I prefer to reduce the appearance of nasolabial folds by restoring lost volume to the cheeks rather than injecting directly into the fold, which can look unnatural. I like to use hyaluronic acid fillers such as Juvederm Voluma or Restylane Lyft in these areas. Based on the photos you have provided; you would not require much filler to see improvement. Please schedule a consultation with a board-certified plastic surgeon to learn more about treatment options for this area.

Jonathan Kulbersh, MD · Answer

Dermal fillers can be safely injected into both the nasolabial folds and cheek regions.  As we age, we lose volume in the face especially in the cheek region. When this occurs the cheeks flattened and sag and will lead to deepening of the nasolabial folds. In reviewing your pictures, you have volume loss in the cheek region. I think injections into the cheek regions to lift, angulate, and defined your cheeks would give use appear result it would be "prettier".  I generally prefer to inject the cheek region over the nasolabial folds. If after injecting the cheek region you still feel the nasolabial folds are deep, you may choose to inject dermal fillers in that region at a later date.I hope this helps

Miguel Delgado, MD · Answer

Hello,Based on your photos, I would recommend filler to the cheek area. This would help "fill in" the area of your cheek that lies underneath your eyes and a bit toward the curve of your cheek, known as the ogee curve, where you are just showing the beginnings of some flattening. It is likely that filling these areas alone will alleviate the nasolabial folds to your satisfaction and also create a tighter looking jawline. I hope your procedure goes well.

Shaun Patel, MD · Answer

One of the most common indications for filler in my clinic is mid-face volume loss. Juvederm Voluma, Radiesse or Restylane Lyft are all good choices for filling the cheeks and in doing so lifting the face. This lift will improve the nasolabial folds. Some patients, however, will require dedicated filler injection into the nasolabial folds. The photos you have provided make it hard to assess the cheeks but I recommend that you discuss your question with your injector prior to treatment. I also recommend that you get treated by an experienced injector.

Corey Frucht, MD, PhD · Answer

Hello, and thanks for your question and photos. For patients with similar patterns of volume loss I prefer to start with volumizing the cheeks, which can have a lifting effect and soften nasolabial lines. If after complete volume correction of the cheeks you're still finding you want more volume in the NL lines, you can have them filled at that time. To maximize the likelihood of a favorable outcome, I recommend that you only get treated by a well-trained dermatologist or plastic surgeon. Hope this opinion is helpful to you. Best of luck, Dr. Frucht.

Steven F. Weiner, MD · Answer

As stated yesterday, the cheeks need addressing first. This might solve your problem entirely. If you look after the cheek filler is done and see the NLF aren't corrected enough, have them filled as well. When looking at volume loss, it is better to look at the face as a unit and not concentrate just on one area. You don't want one area to look great and other areas to not look so good, this looks abnormal.

Steven Wallach, MD · Answer

Fillers in the cheeks may soften the folds slightly, but fillers in the folds are still important as well for direct improvement.

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