Will Botox help minimize the appearance of my nasolabial folds / crease? (photos)

Question

Hello , I have a crease around my mouth that bothers me a lot. I'm afraid that HA filler in this area will just add more volume to my lower face, can it be treated with botox? Even when I pull my skin up, this crease is still showing.

Jonathan Kulbersh, MD · Answer

Thank you for your question and photos. While dermal fillers do add volume, the nasolabial folds you’re referring to can be directly targeted to volumize the creases without adding unnecessary fullness to the rest of your face. If you’re unsure about filler, you can also consider RF microneedling treatments to smooth the fine lines and tighten the skin by increasing the body’s natural collagen production. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon or injector. They will be able to discuss your concern with you and suggest the best treatment option.

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

Although, in general, sophisticated, experienced filler injectors no longer "chase wrinkles" by simply direcrtly filling them up (and instead use fillers in the appropriate anatomical locations to achieve the most optimal results), there are instances where it is still best to address the wrinkle or fold directly. True, for the most part a robust HA filler in the cheeks will not only create a more desirable oval, heart-shaped face, but secondarily soften the smile lines. However, as apparently is the case here,  where augmenting the cheeks with a robust HA filler risks making the face too wide or full-looking, it would be more prudent to use a cohesive, low viscosity HA filler directly injected into the smile lines to soften their appearance. The use of Botox in this area is not generally recommended for this location, since it may affect the ability to smile normally. You would be wise to consult an experienced, board certified cosmetic dermatologist. Best of luck.

Camille Cash, MD · Answer

Botox works by affecting the ability of injected muscles to contract.  This can soften the look created by this muscle contraction.  Botox would not correct the issue that concerns you as it is not related to muscle activity.  Visit with an experienced injector near you to discuss your options.  Filler is the most commonly used product to address nasolabial folds.

Geeta Yadav, MD · Answer

Thank you for your question! It’s likely that you’d benefit from dermal fillers to lift the area and soften the appearance of your nasolabial folds. An in-person evaluation is ideal to determine the best course of treatment for you, and during your consultation, an experienced injector will be able to decide if you should be injected within the smile lines themselves or in the cheeks (or both!). Hope this helps!

Dean P. Kane, MD, FACS · Answer

Dear kbendi, 
Thanks for sharing your photos. 
As we age, particularly after 30, restoration of collagen and other structural skin molecules diminish. The mobile skin and underlying soft-tissues are teathered to the deeper tissues centrally and along branches: forehead and lateral eyes, nasojugal fold, nasolabial fold, marionette fold and central neck.  With gravity and passive skin laxity, particularly with weight loss and / or lipo volume loss, the skin sags into folds and waves. Your lips look marvelous due to the filling of the compartmentalized lip volume loss; one option is to fill your upper cheeks to do the same. Your second photo illustrates the lifting action and a second option to “drag” the wave back from where it came from. 
Other options include:
Thread lifting and  facelift if there is a need for excess skin removal
Overall tightening of the face: retinoids, chemical peels, Sculptra
The only muscle botox may have a minimal action on is the DAO, relaxing the downward pull of the corners of your mouth. 
You will need a hands-on evaluation to see what is best for you. Please consult with a talented Board Certified Plastic Surgeon who is skilled in these non-surgical, minimally invasive and surgical areas of expertise. 
All the best!

Milan Doshi, MS, MCh · Answer

Thank you, kbendi for your question and photographs.
 Photographic evaluation is incomplete without personal examination to give the most appropriate answer
 However from the photographs, it seems that,
Oly doing botox by the angles of the mouth will not do the job but botox along with filler will do a wonderful job the reason being that as your angles are drooping then first you can do a botox and wait for 15 days and see how much of a lift is there in the area and go to a board-certified dermatologist. If you are still dissatisfied with the results then you can go for a few fillers which can give you a lift without giving it too much volume thereby giving you a much better appearance.

Please consult a board-certified plastic surgeon near you and discuss this in detail.
Wish you an alluring look

Chuma Chike-Obi, MD · Answer

Unfortunately, botox will not help with these areas. Nasolabial folds, marionette lines.HAs do add volume, so that is a valid concern.
The best path depends on what previous treatments you've had.

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