Treatments to soften nasolabial folds? Fat graft/implants/facelift? Want a more permanent solution than fillers (photos)

Question

Hi! I am unhappy with how my nasolabial folds look, they're especially pronounced on my left side. I was wondering what treatments would be best to diminish them? I have done fillers in the folds directly, also in the cheeks and in the piriform (pics attached are several months after fillers). Fillers help a bit but not as much as I would hope. I'm 28 but I've had pronounced nasolabial folds my whole life, so I believe it's not just a matter of aging but also a structural issue.

Randy Wong, MD · Answer

You are correct that this is a structural issue, not a volume deficiency.  Even supermodels have these lines when they smile, as the folds are muscle attachments to the skin.  Fillers, fat and other volume enhancements may migrate into the cheek, making the problem worse over time.  The structural issue is the heaviness of skin from the cheek folding over the muscle/skin attachments.  You may want to consider mid face suspension, barbed sutures, or other minimal access cranial suspension techniques.  Discuss these options with a board certified plastic surgeon for more information.

Zoran Potparic, MD · Answer

Based on these photos, you appear to have very mild NLF, asymmetric. At the time being and considering your age, fillers may be the best solution; fat grafts/nano fat grafts unfortunatelly do not work well in this area due to mobility. You may consider changing a service and visit a more experienced board certified plastic surgeon? Good luck.

Edwin F. Williams, III, MD · Answer

Thank you for this question! There are a few treatment options to help soften up the nasolabial fold. For a young patient like yourself, filler injections often work great as you mentioned. Fillers can be injected underneath the folds, or sometimes they can be injected into the piriform aperture to soften up the hollowing and sometimes even to the cheeks to provide a subtle lift. For an older patient, a facelift can also help soften the folds by stretching and lifting the face laterally.

David M. Kowalczyk, MD, MBA, FACS · Answer

Good Morning! The nasolabial folds can definitely be tricky to correct. If you've tried fillers, fat transfer can work well. Fat can be harvested from around your belly button and injected into the folds. The results can be quite nice and often last 5-10 years on average. Overcorrection is initially necessary as 30-50% of the injected fat can not survive the transfer. Seek consultation with a facial plastic surgeon to learn more. Hope this helps!

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