Uneven nasolabial fold. How is this problem corrected? (Photo)
Doctor Answers 13
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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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.
Learn more: https://www.youtube.com/channel/UCa6C2fuS-AgOnvBjr6_VSQg
Learn more: http://www.dennisgrossmd.com/services/treatment/dermal-fillers/
Learn more: https://www.stevenwallachmd.com/non-invasive-procedures/restylane-restylane-lyft-juvederm/
Learn more: http://www.nelson-center.com/dermal-fillers.html
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
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.
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