What treatment is best for Nasolabial Folds?

Treatment of the nasolabial folds can be performed with fillers to the nasolabial folds, fillers to the cheeks to lift the soft tissue hanging over the nasolabial folds, or surgery to lift the soft tissues, or a combination of the three.

There is not one "best" treatment for the nasolabial folds.  Multiple options are available with variable benefits and drawbacks.  In addition, each treating physician may have his/her own reason for favoring a particular treatment option.  The goal in treating any nasolabial fold is to decrease its depth make the face appear smoother and younger.  While a facelift can be helpful in elevating the cheeks back toward their proper position, filler agents are a great approach to use and avoid or delay surgery.  Many patients who have a facelift also require filler agents in the nasolabial folds.

The variety of filler agents includes hyaluronic acid agents (eg. Restylane, Juvederm, etc...), calcium hydroxylapatite (Radiesse), and Polymethylmethacrylate microspheres (Artefill).  Autologous fat grafting is another approach.   Hyaluronic acid agents are relatively simple to use, effective, and reversible.  Many also come containing lidocaine (local anesthetic).  Radiesse may last a bit longer than hyaluronic acid, but costs a bit more and is not easily reversible.  There is also a somewhat higher rate of late nodule formation and it should not be used in the lips.  Artefill is a semi-permanent agent that is also more expensive and cannot be reversed.  While lasting a long time can be of significant benefit, it can also be problematic if you are unhappy with the appearance.  

Fat grafting requires aspirating fat (liposuction) from another area of the body and then injecting it into a target area, such as the nasolabial folds.  Successful fat grafting results in permanent  improvement to the treated area as the graft continues to live as a graft.  Another benefit is that it is derived from your own body.  Fat grafting is probably the most expensive option because of the associated liposuction and fat preparation.  It may also require more than one treatment.

One other consideration in regard to filler agents and your face is Sculptra.  If your cheeks are somewhat hollow they could potentially benefit from some increased fullness or volume.  Sculptra (poly-L-lactic acid) is usually injected on 2-4 occasions and has a subtle onset.  It can last up to two years.  Good luck.

In the absence of significant skin sag, injectable fillers are an excellent option for treating nasolabial folds. When utilizing this approach, a large variety of injectable fillers are currently available. Examples include Restylane, Perlane, Juvederm, Sculptra, Artefill and Radiesse to name a few. The filler chosen is dependent on the patient’s anatomic findings, aesthetic goals and the surgeons comfort level.
In the vast majority of cases, we prefer either Juvederm or Restylane when treating these lines. Although there are differences between these products they are both associated with excellent clinical results. Both fillers last about 6 to 9 months and are associated with high satisfaction rates.
If patients are satisfied with the results of their injections, we occasionally switch to a longer lasting injectable. In most cases we prefer Radiesse which can last 2 to 3 years.
If you’re considering injectable fillers for nasolabial folds, consultation with a board certified plastic surgeon is appropriate. This surgeon should be able to formulate an appropriate treatment plan for this problem.

For most individuals, the use of a dermal filler such as Perlane or Juvederm is the treatment of choice.  It is a quick procedure with immediate results with no downtime and very little risk.  

For individuals who need volume in the cheeks as well, the use of a filler like Sculptra is the ideal treatment because it can give back the youthful appearance of full rounded cheeks while softening the folds.  Because Sculptra induces an individual's own collagen productions, it takes 2-5 treatments over several months to achieve the full effect.  The results are gradual but long lasting  (2 or more years).