What is the most long term fix for nasolabial folds?

Question

I am 61 with very few wrinkles but I have had sagging which makes me look like I am frowning all the time. I don't want to have to do fillers on a regular basis. I would rather not have a full face lift and I don't think I need that. Do the Sono Bello type treatments work well for this type of issue or is a mini face lift worth it. If possible I would rather no surgery and cost would be a factor. Obviously I asking generally speaking. Most people think I am 50 or so. Thank you

Jonathan Kulbersh, MD · Answer

Congratulations on taking care of yourself and looking young for your age! It would help if you would post photos so that we could answer you more specifically. In general, I would not recommend fillers except to counter the very early stages of aging – usually in the 30s and 40s. Once there are significant creases and sagging, the best “fix” is a Mini Lift. In my practice a Mini Lift addresses lower face sagging and smooths out the jawline.  It can include a neck lift with platysmaplasty to clean up the neckline if indicated. It's a very rejuvenating procedure that will turn back the clock about 8 years and last at least that long, too.
I don't have personal experience with Sono Bello, but have not been impressed with the long-term results of nonsurgical skin-tightening procedures; they don't last. Liquid face lifts also must be repeated every year or two. The costs of these procedures add up quickly. If affordability is your main concern, you may be able to work out a payment plan with your facial plastic surgeon. I hope this helps.

Jason Emer, MD · Answer

I recommend fillers to soften the nasolabial folds themselves and also lift around the mouth and cheeks to build underlying anatomical support. In our practice we combine Sculptra with other fillers "layered" on top and lasers, skin tightening treatments such as Thermage, Fractora, and Renuvion (J Plasma), thread lifting,  and peels to get the most conservative, natural look. I suggest seeing a facial sculpting expert for a formal consultation. Best, Dr. Emer

Amir Nakhdjevani, MBBS, MRCS, FRCS(Plast) · Answer

Thank you for your question, unfortunately if there is skin laxity where it has lost elasticity only surgery would address this.  Putting fillers in the nasolabial folds would just create more heaviness, making that area look more prominent.  
Most of my patient want to remove the skin laxity however do not want the downtime associated with a traditional facelift.  The Concept Facelift is the procedure I perform, which combines the latest surgical techniques with the use of local anaesthetic to dramatically reduce the risks associated with traditional facelifts, while significantly reducing the bruising and downtime of your recovery, from months to a matter of days. 
If you have lax facial skin, lost volume and feel that you have jowls and wrinkles on your cheeks and you look tired when you're not then the concept facelift can help improve your appearance. With concept facelift you will look natural and fresh just like the way you feel inside. There are no bandages, drains and hospital stay but with lasting results of traditional facelift techniques it fits with today's age.
What are the benefits of a local anaesthetic facelift?
Minimally invasive as it is a short scar faceliftThere is minimal bruising and swelling, especially when compared to traditional faceliftsAs the procedure is performed under local anaesthetic, you can go straight home following the procedureFull recovery in a matter of days rather than monthsSignificantly less risk than Facelifts performed under general anaestheticFresh, youthful and long lasting resultsPlease make sure you find a reputable and qualified plastic surgeon who can assess you properly to give you a realistic idea of what outcome you can achieve.  All The Best

John Michael Thomassen, MD · Answer

The best treatment for nasolabial folds is a high SMAS flap facelift.  Lasers do not address this area unless we are talking about a very fine wrinkle.  You can do this procedure under local anesthesia to help reduce costs.

Thomas Buonassisi, MD · Answer

Your situation is very common. Think about the aging process as a combination of sagging of skin, volume loss and surface texture changes. Each of these is addressed differently. Surgery can tighten skin, fillers (fat of synthetic) can replace volume and Skin treatments (BBL, laser, chemical peels) can improve the texture. There is no perfect single treatment.I would suggest you see an honest well respected plastic surgeon who offers all of the above treatments. Evaluate the costs and downtime and decide what is best for you.Good luck!Good luck

Keith Denkler, MD · Answer

The nasolabial folds are a combo of deflation and wrinkles.Treatment would address the deflation with fat or fillers and wrinkles would be pulled smooth via a lift.Sometimes filling alone is enough, but over time some pull is best.Aging continues so in ten years further changes will occur that you may wish to treat.

Paul J. Leahy, MD · Answer

Thank you for your question. It's just so hard to accurately respond without seeing you in person (or at least a photo). Generally though, a mini facelift can work well if it is your jowls/lower cheeks that are "sagging" and causing you to look older. Alternatives to the HA fillers might be to consider fat grafting. This is a relatively non-invasive procedure. I hope that helps.

Keith Ladner, MD · Answer

Fat grafting is a very safe, long-lasting, natural-appearing alternative to fillers. The melolabial fold is one of the most commonly treated areas with fat. The fat is typically taken from the patient's thighs or abdomen and carefully injected into the areas of the face that need more volume.

Tracy E. McCall, MD · Answer

In general, surgical procedures are going to last longer. There is the midface lift, which addresses the nasolabial fold well. You can combine this with fat grafting. Or you can do fat grafting on its own. There are a number of fillers that last more than a year. There is one that will last 5 years. However, the things that made your face droop to begin with will still be affecting your face and your results. You can start with fillers to see if you like the results. It is best to start with a cheaper, not permanent, option to see if you like it.If you don't mind the drive to Wisconsin, I'd be happy to do a full consultation and review all your options. Call Suzanne at 262-523-1200.

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many facial shaping procedures using dermal fillers, facial implants (cheek, chin), liposuction and/or facelifts for over 30 years.  Non smiling photos of your face from the front and side would help in the evaluation.  In my experience, tissues sag off the cheeks creating nasolabial folds when there is inadequate cheek bone volume to support them.  The more flat or concave the cheek bones are, in the front section of the cheeks, the greater these tissues sag and at an earlier age.  As the facial tissues sag towards the nose and mouth the nasolabial folds and "jowls" are created.  I have performed facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  It's important to keep all of the "heavily marketed" non-invasive skin tightening procedures in the proper perspective.  Non-invasive techniques typically shrink the skin several mm's.  There are 25.4mm's in one inch.  The minimally invasive facelift described below can remove 2 to 3 inches of skin which equals 50.8 to 76.4 mm's or up to 25 times the amount of loose skin provided by non invasive skin tightening techniques.  That reality should always be front and center in the decision making for prospective facelift patients.  It should also be noted that non invasive techniques have no ability to properly dissect, elevate, trim and re-suture the SMAS layer or precisely reduce excess fat below the skin making them one dimensional at best.  
 Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.
 If you have "jowls” these are sagging facial tissues and an indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.
Hope this helps.

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