What do I do about these parentheses?

Question

These are not nasolabial folds, they are the "nested parentheses" lines that are around the corners of my mouth that are increasing in number. This one, on the left side, is not present on the right at all. I am afraid that filler will migrate and cause lumpiness under the chin, and am thinking that a laser might soften it? Please help! I hate this, it's extending all the way under my chin.

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

Nelson Lee Novick, MD · Answer

Take a breath. Your problem is not so unusual. In fact, it is quite common.  Filling each of these lines directly with a hyaluronic acid filler, such as Belotero Balance, which possesses little to no significant risk of giving rise to the bluish/gray Tyndall Effect, is one possible way of dealing with this troublesome issue. However, the repetitive movement of the area typically leads to only short-lived benefits. Instead, the use of a skin booster fanned with a cannula throughout the area as well as directly into each of the lines not only smoothes and tightens the skin, can yield quite gratifying results. And, the procedure, in experienced hands takes only a few minutes to perform. In my Israel satellite facility, where  a far greater number of regulatory agency approved skin boosters are available, I would opt for Viscoderm Hydroboosters for this purpose and in my NY practice, I would choose Restylane Silk. Make sure that you consult with a board certified aesthetic physician. and ask to see his/her personal before and after photos before agreeing to proceed. Best of luck.

Paul Flashner, MD · Answer

Hi there,Thank you for your question and photograph. There are several different options to improve your concern, such as Laser Resurfacing or Skin Tightening or both. Laser Resurfacing devices will help soften the lines, while Skin Tightening devices will help improve laxity and pull back the skin. I recommend an in person evaluation with your local Expert. They will assess your concern and determine the best treatment plan for you. Good luck.

Gordon Andan, MD · Answer

The lines you’ve shown in your photo aren’t uncommon and typically respond nicely to carefully placed filler. As long as you seek out an experienced, skilled provider who understands how and where to place the filler in order to achieve the desired result, you shouldn’t have to worry about lumpiness or product migration. You could still combine laser treatments with the filler if you decide to go that route.

I would recommend sitting down with an experienced cosmetic surgeon to discuss your goals and concerns in more detail and to get a personalized treatment plan.

I would recommend sitting down with an experienced cosmetic surgeon to discuss your goals and concerns in more detail and to get a personalized treatment plan.

Andres G. Sarraga, MD, FACS · Answer

The marionette lines that you are referring to can be improved with filler. Laser can help erase these lines too. A facelift can also help correct these stubborn lines.

Shaun Patel, MD · Answer

Great question. This superficial lines/wrinkles are best treated using a combination of different treatments:1. Small amounts of a softer HA filler like Restylane Refyne can be injected intradermally into the lines.2. Laser skin resurfacing or microneedling with PRP can also soften the lines. 3. Medical grade skin including a retinol will stimulate collagen production and further improve the lines.

Shelin Tkatch, MD, FRCSC · Answer

Thanks for the photo. You are lucky to have a variety of treatment options and I would suggest best results will be obtained with a combination approach. First, you need to be on a medical grade skin care program that includes antioxidants, growth serums, retinols and sunscreen. Non-volumizing fillers to address skin elasticity, such as Beletero Balance or Restylane SkinBoosters, can help diminish the parentheses without over volumizing you. Collagen building treatments such as microneedling and fractional lasers will round out the treatment plan. A comprehensive treatment plan will not be inexpensive, but if you hate those lines, there is help available. Best, Dr. Tkatch

Center for Aesthetics and Plastic Surgery - Grand Rapids · Answer

Hello there,
      I have treated many of these lines. I would recommend a multi-treatment approach.
The foundation of everything is skincare, so using medical grade skincare to stimulate collagen and elastin, will reduce the appearance of these fine lines. Good skincare will also slow the aging process, therefore preventing these lines from getting worse as well as preventing new wrinkles. 
I also would recommend either Halo laser or micro needling. These treatments will stimulate collagen and elastin even further. Additional benefits of these two procedures include pore-reduction, pigmentation correction, and texture smoothing. 
If these items do not soften these lines to your desired level, then filler injected directly into the wrinkle will greatly improve the area. Typically a combination of these treatments is done for the best, longest-lasting results. Hope this helps.
Sarah RN BSN

Camille Cash, MD · Answer

You will probably achieve the best results from a combination of treatments.  Lasers or microneedling can help with skin tone and texture.  Fillers can help to contour the face.  We also recommend using medical grade skin care and wearing sunscreen every day.  Begin with a visit to a board certified plastic surgeon near you to discuss your concerns and learn about the available treatment options.

Julie Shelley, DO · Answer

Hello, and thank you for your question and photo! I think a combination treatment would likely give you the optimal results you are seeking. I would recommend a series of laser skin tightening treatments with a radiofrequency laser. This would help soften the fine lines and wrinkles around the mouth. Microneedling with PRP would also help stimulate collagen production and help fill in some of the fine lines and wrinkles. Lastly, I do believe that a small amount of hyaluronic acid filler injected into the fine lines would help. I recommend having an in-person consultation with a physician who is well trained in these procedures. I hope this helps!

What do I do about these parentheses?

Answers (11)

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