Where to fill: cheeks to lift nasolabial folds or just nasolabial folds? (Photo)

I have had two consultations regarding my nasolabial folds. Both docs said they would fill them, not my cheeks. I asked about injecting cheeks to address the folds by lifting cheeks. I have another consult with a third doctor. Am i wasting my time on consults or can the problem area be addressed by injecting cheeks? I do not want a wider moon face as i fear only filling the folds will give me

Doctor Answers 9

Chicken or The Egg

The goal of restoring midface beauty is accomplished in many different ways. As we get older we loose bone in all of our body. The same happens to facial skeleton as well. As the cheek bones get smaller they sink into the face and cannot hold up the soft tissues that used to make a beautiful apple cheek in our younger years. It is obviously exacerbated by the loss of elasticity in the soft tissues. As the tissues descend towards the lower jaw and lips they end up creating a fold called 'Nasolabial Fold' also known as 'Nasolabial Groove' or Smile lines. 
So this makes it very clear that the loss of cheek volume comes first and then the nasolabial fold. Hence the chicken came first or the egg mystery has been solved. Next the issue is how to treat it. I always leave it to the patient to decide. If they want nasolabial folds to be softened only then any filler will achieve that. However a better or more aesthetic approach is try restoring the structure of the face to what it used to be. To achieve that a filler should be used to rebuild the cheek bones to lift the tissues back up from the nasolabial folds to the apple cheek area where they belong. This works very well in the early aging years. With time it can be quite advanced and you need to approach the nasolabial fold directly as well. This issue has been addressed by mid face lift as well. 
Dr. J

Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 88 reviews

To fill nasolabial fold or cheeks depends on your concerns

If your only concern is the appearance of your nasolabial folds, then you should just have your nasolabial folds injected. The major benefit of injecting your nasolabial folds directly is that you will require much less product then if you were to have your cheeks injected. Also, you will have less swelling and less risk of bruising. The exception to this is when there is a significant amount of cheek volume loss. In this situation, if you fill the nasolabial folds it creates an unbalanced appearance and you look like you have a muzzle.

Now, if you are concerned about the appearance of your cheeks and nasolabial folds, then I would recommend addressing your cheeks first. Framing your eyes with cheeks that have a gentle youthful convexity has a much greater aesthetic impact then filling the nasolabial folds alone. Once the cheeks are corrected most patients do not see the nasolabial folds as much of an aesthetic concern. Therefore, a small percentage of patients will go on to have their nasolabial folds injected after their cheeks are corrected.

Paul Stanislaw, MD
Avon Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

Two different issues

Filling your upper cheeks will restore needed volume to your cheeks and help give you face more of a Vshape.  Filling the nasolabial folds will soften them.  Generally filler in the cheeks has little affect on the nasolabial folds.  
From you photos, I would probably recommend both areas.

Stuart H. Bentkover, MD
Boston Facial Plastic Surgeon
4.8 out of 5 stars 24 reviews

Where to fill: cheeks to lift nasolabial folds or just nasolabial folds? (Photo)

Thanks for your question.
I find it amusing that you have the answer and the two doctors did not. This just reinforces the theory that one needs to have an aesthetic eye first and the ability to inject second!!
I totally agree with you, you need cheek fillers first before NL folds, for the reason that you have mentioned.
I do all the cosmetic injecting in my practice and this is the approach I take.
All the best

Contouring The Face, Not Chasing Lines & Wrinkles, Is Our Current Approach To Nonsurgical "Liquid" Facial Rejuvenation

For the past few years, the emphasis in nonsurgical facial rejuvenation with injectable fillers and volumizing agents is "deep support volumetry" to contour the face in three dimensions. Aging of the face involves the loss of fat from various fat compartments, including the cheeks, temples, lips, and chin, along with loss of bone and cartilage--all of which lead to sagging and jowl formation. Loss of cheek fat and cheek bone recession, particularly in the mid-facial region leads secondarily to the development of nasolabial folds. 

Since loss of volume in the cheeks is the primary cause of the development of the smile folds, directly replenishing the volume to the cheeks can not only restore the proper projection and light reflection to the cheeks themselves, but can secondarily help to soften the smile lines themselves, often without the need for directly injecting them (something that was common practice when I first began treating wrinkles over thirty years ago with the original Zyderm and Zyplast collagen fillers). In my Upper East Side Manhattan office I would opt to use Voluma XC and Radiesse for this purpose. In my Israel satellite facility, where a far greater number of regulatory agency approved fillers and volumizers are available I would opt for Stylage XXL and Emervel Volume.

Nowadays experienced, expert physician injectors do not simply chase after wrinkles by filling them. Like sculptors, they must instead attempt to balance and contour the face by restoring the lost volume to the places where that volume existed earlier in life. In fact, when it comes to the smile lines, filling them directly and erasing them can give rise to an unnatural look--to what has been referred to as the "simian look," the flat-faced central face of a monkey. 

Once the appropriate 3D contouring has been achieved by volumization, individual etched-in wrinkle lines, such as may occur in the nasolabial folds after years of emoting, can be smoothed, if so desired, through the use of a superficial filler (rather than a more robust volumizing filler). 

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.8 out of 5 stars 22 reviews

Filler into just folds or cheeks

I think part of what's missing from the discussion is the idea of price here. Adding volume to the cheeks will definitely help enhance your look, and if done correctly, will NOT round out your face but actually give you more defined features. You may indeed also need fillers done separately to the NLF lines too. The issue comes down to volume and price. Adding multiple syringes to the cheeks and to the NLF lines would certainly give you the best overall look; however, it's going to cost a significant amount. I'd have a hard time thinking you could get away with any less than 4 syringes of filler to do both of those areas. That's going to cost a good amount of money. So, I'm assuming that some of these doctors discussed your price point with you, and if you didn't want to spend a few thousand dollars, they may be giving you the option that fits your price, which may not be able to address all of the issues.

"This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

Nasolabial folds

Everyone is correct. You are right that filling the cheeks can lift the soft tissues a bit, but also injecting the nasolabial folds directly will help as well.  I commonly treat both areas.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Where to fill: cheeks to lift nasolabial folds or just nasolabial folds?

I am not sure why the doctors suggested only the folds.  I would absolutely suggest the cheeks and the folds. Filling the cheeks alone will not address the folds...both will need to be injected.  Your cheek area on your right side is especially flat.  Women appear more youthful and beautiful when they have a soft, round, feminine cheek.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Both is best

Thanks for the photos!  You've had some loss of volume of your cheeks and filling that in will give you a more natural look - so long as it's done by someone experienced.

I do this often and find that it reduces the amount of filler needed for the nasolabial area with a more natural result.

Jeffrey H. Spiegel, MD
Boston Facial Plastic Surgeon
4.5 out of 5 stars 35 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.