Uneven nasolabial fold. How is this problem corrected? (Photo)

I recently had two syringes of Juvederm placed in my nasolabial folds and into my lips. Ive always been told that one side of my face is wider than the other. Every time I get filler in my folds, they look uneven. How is this problem corrected? Do I need more fillers in my cheeks (had radiesse back in February)

Doctor Answers 13

Nasolobial folds may occur in young people due to bone structure, not aging. Balancing the whole face can help

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Thank you for your question. You submitted a photo and say you had 2 syringes of Juvederm placed in the nasolabial folds and in the lips, and you’re concerned the nasolabial folds tend to be uneven, even after filler placement, so you are asking how to address this. You’ve been told one side of your face is wider than the other.

I can give you my perspective as a specialist: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years. I do a lot of injectable fillers for mostly facial aging-related changes, and I use Juvederm and other fillers to help people with this. For a situation like yours, I’ll  share with you how I explain to people what the nasolabial folds are relative to global facial asymmetry.

You are certainly on the right track. It is well known in our field that one side of the face is not the same as the other - it is always one side that is a little more recessed, or sometimes wider. These differences are part of natural asymmetry. Another important factor of asymmetry is based on bone structure - bone, muscle, fat and soft tissue revolve around the structure of the bone. When people notice their nasolabial folds getting deeper, very often they’re concerned about softening those nasolabial folds and the marionette lines. These lines getting deeper are a reflection of volume loss.

When we look at people from a global perspective of bone, muscle, fat, soft tissue, in addition to dealing with these lines with filler at the dermal level, we also address the bone structure with a procedure called structural volumizing. This means we use fillers such as Juvederm and Voluma placed directly over the bone structure and under the muscle so they provide support that can compensate for different levels of asymmetry, and further enhance the appearance of the nasolabial folds. A lot of very young people have deep nasolabial folds because that’s the way their bone structure is, and not because of aging. We do this procedure to restore volume in the cheeks and jawline. Very often, you won’t need something to improve the nasolabial folds because the volume correction has restored balance to the face.

When you look at the nasolabial folds, you have to think this is a line where the skin is relatively thin, and there are deep attachments. The amount of filler you can place there is subject to the elasticity of the tissue, and the ability to really elevate. There is a limit of how filler you can put under the lines, as well as the dermis, which is the backbone of the skin, which is very thin.

Learn about this concept about structural volumizing and about global facial volume. Take a step back and look at your face to see if there is benefit in putting volume in the cheek area, and if that would balance the area out. I often noticed that patients will focus on lines, and sometimes miss the forest for the trees. When we do our evaluations, we actually put their photos up so they see what we see as someone who is meeting them for the first time, and look at the overall balance. Very often, restoring volume in the critical areas where volume is lost actually balances everything out, and the nasolabial folds don’t look as deep as they initially did. I hope that was helpful, I wish you the best of luck and thank you for your question.

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New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Treating uneven nasolabial folds

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Most people have asymmetric or uneven nasolabial folds. These folds can be corrected by injecting directly into them, as well as by injecting above them in the medial and/or lateral cheek. Best to see an expert injector such  as a dermatologist to try and correct this ; note that sometimes it is not correctable.

Benjamin Barankin, MD, FRCPC
Toronto Dermatologic Surgeon

Uneven nasolabial fold

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Juvederm treatments are completely customizable to the patients face.  You can potentially add a bit of filler to the cheek of the deeper fold to get a bit more lift.

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 521 reviews

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Asymmetry of nasolabial folds

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Juvederm Voluma in the cheek might improve this asymmetry and avoid overfilling of the nasolabial fold. If this does not resolve the asymmetry of the nasolabial folds to your satisfaction, injection into the pyriform area would probably improve any residual asymmetry. Best wishes.

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Facial Sculpting Using Fillers Like Voluma, Radiesse, Lyft, Juvederm and Sculptra and Fat

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Fillers, implants and fat can all be used to sculpt and contour the face. Additional filler can be placed to improve facial symmetry. I suggest consulting with a facial sculpting expert. Best, Dr. Emer

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Filler to Correct Uneveness

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There is no reason why this should not be able to be improved upon - most everyone has some sort of asymmetry to their face, which is why I believe fillers and Botox require a completely customized approach. The in-person consultation is key for understanding a patients concerns and goals as well as assessing facial structure so that we can customize  a treatment plan to fit your needs. My best advice for you would be to seek out a board-specialized dermatologist or plastic surgeon with a lot of experience with injectables as well as a great track record. Unless you find someone willing to take the time to customize the treatment to your specific needs, you may get the same result.

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Uneven Nasolabial Fold after Juvederm

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You might benefit from additional filler to the left nasolabial fold.  You might also benefit from injections of filler to the left cheek if the left cheek is less full compared to the right side.  Putting filler into the cheeks can help lift the nasolabial fold.  Make sure that you are seeing an experienced injector, preferably a cosmetic dermatologist or plastic surgeon.Regards,Dr. Ort

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Facial asymmetry

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Everyone's face is a bit asymmetric and therefore, one fold is often deeper than the other. Best to be seen in person to determine how to better balance the two sides.

Steven Wallach, MD
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Uneven nasolabial fold. How is this problem corrected?

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Thank you for your question and for sharing your photograph.  Nasolabial folds are often asymmetrical in patients, and require an uneven placement of dermal fillers.  I see your area of concern and if it is has been at least two weeks since your treatment I would recommend additional JVD placement into your left smile line to help smooth the transition from your cheek to your upper lip.  It would also be important to check on your left cheek relative to your right.  If your left cheek is smaller, placement of filler material into the left cheek can help improve the nasolabial fold and lower the amount of filler that may need to be placed there.   Hope this helps.

Nelson Castillo, MD
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Uneven Juvederm Injections

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The simple answer is that you can add more filler in the nasolabial fold on the left and it should look more symmetrical. But looking at the limited picture, the left check has more volume loss and I would recommend actually putting the filler into the left cheek to give a lift which will naturally soften the laugh line and make you look more balanced.  When I see clients concerned about their laugh lines, I evaluate their cheeks and this is usually the first place filler will be injected to create a lift and if they want more softening , then I will consider placement of a small amount in the laugh lines themselves.  Too much filler in the laugh lines can look unnatural and almost impart a simian like characteristic. I would go back to the provider and have this discussion with them.
All the bestDr Soni

Hardik Soni, MD (not currently practicing)
Summit Emergency Medicine Physician

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