Nasolabial folds filler hasn't worked? Juvederm

Question

I had my naso folds filled in 4 days ago & i am very disappointed in the result. I had 0.5 on each side, never had it before and as the days have gone on it just looks the same? Shall i go back?

Carlos Mata, MD, MBA, FACS · Answer

Hello there,Thank you for your question and I'm sorry to hear about your concern.  Often, patients come to my practice and if they want a correction simply with fillers, they are surprised at the amount of volume needed to achieve a full correction.  Unfortunately, if just correcting the nasolabial folds, you will not be happy with the results.  I see volume loss in your cheeks and my recommendation is always to treat that area first and then supplement treatment in the nasolabial fold region because it's the difference between treating the problem or treating the symptom.  Once volume is restored in your cheeks, you will be able to see a significant difference in the way your nasolabial folds look.  I would highly recommend seeing a physician who has extensive experience in filler injections.  Hope this helps.All the best,Carlos Mata, MD, MBA, FACSBoard-Certified Plastic Surgeon

Kevin Mosca, DO · Answer

Alot of times when you read the fine print on the demo flyers in the office you will see that the patients used 2-4cc of filler to achieve the results they desired.  You may just need to have more filler injected in each side as 0.5cc is not alot.

Nelson Lee Novick, MD · Answer

I am sorry that you are so disappointed with your treatment. However, after viewing the photos I am hardly surprised for several reasons. First and foremost, these days only novice, inexperienced injectors directly "chase after lines and wrinkles," such as the smile lines, by filling them directly with an ordinary filler, such as plain Juvederm or simple Restylane. This approach, while common over three decades ago, has largely been abandoned by experienced physician injectors in favor of restoring facial youth"fulness" by replacing the volume in the cheeks lost with aging, which is responsible for the development of jowls and smile folds. From the photos, there is considerable mid-cheek volume deficit that if replaced with a volumizing filler, such as Voluma XC (my choice in my NY City office), would not only make the face overall more pleasingly oval, but would like significantly lessen the smile folds (without even needing to directly inject them). I did precisely that for a patient two hours ago with the result being a significant overall improvement in facial contour and a profound diminution in smile folds. For the latter, in my Israel satellite facility, where a far greater number of regulatory agency approved volumizers are available, I chose Stylage XXL. Moreover, even if direct injection of the smile lines were indicated, the amount of Juvederm injected was woefully insufficient to have been expected to achieve much of anything.  I would suggest consulting with an experienced board certified aesthetic physician and make certain to ask to see his/her before and after photos before agreeing to proceed. Best of luck to you.

Michael A. Zadeh, MD, FACS · Answer

The reason your filler didn't work is because you didn't get enough of it. 0.5cc per side is not gonna show a difference for most people, unless the folds are very mild. Looking at your pictures, you would need anywhere from 1-2 syringes per side. Choice of filler is also important. Make sure you're under the care of an experienced injector. Best wishes.

Jason Emer, MD · Answer

Keep in mind, it takes 1-2 weeks for final results with fillers. A combination approach would give the most improvement. There are a lot of options for improving the nasolabial folds and this often means fillers for the folds themselves but also lifting around the mouth and cheeks to build underlying anatomical support. In our practice we combine sculptra with other fillers "layered" on top and lasers, rf treatments and peels to get the most conservative natural look. Please see a facial sculpting expert. Best, Dr. Emer

Nelson Castillo, MD · Answer

Thank you for sharing your excellent question and photographs.  In order to maximize your results I would first recommend having filler placed into your cheeks to add volume and to help elevate the tissues around your mouth and lower eyelid.  Once your cheek volume is at a level you like, additional filler can be placed into your lower eyelid and smile line regions to optimize your outcome.  A 0.5cc of filler into each NLF is too small an amount to see material changes.  Hope this helps.

Christian N. Ford, MD · Answer

Thank you for your question and for sharing your photographs.  Sorry that you are having some concerns about your postprocedure appearance.  Based on your photos, I would suggest volume replacement in your cheek area with Voluma, in addition to optimizing the amount of Juvederm in your nasolabial folds.  One syringe is simply not enough product to achieve your desired result.  Please be sure to see your injector for an in-person reevaluation to fully discuss your concerns and your goals and expectations in order to determine the best treatment plan.  Beautiful and natural results can be achieved by using a combination approach with Juvederm and Voluma.  Hope this helps and best wishes!

Steven Wallach, MD · Answer

You have severe facial waisting. You likely could benefit from more filler or even fat grafting.  Best of luck.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question Wugmamma. I understand your concern. Juvederm is a hyaluronic acid filler designed to enhance the
appearance of the face. 0.5 cc is a very small amount. I usually recommend that my patients start with one syringe (1 cc) per side. This is a conservative amount. Results are assessed 2 weeks later once swelling has subsided. At that point more product can be added if further enhancement is desired. If I had a patient who looked like the person in these photographs I would say she is also a good candidate for Voluma. Please consult with a doctor for specific recommendations. Good luck!

Steven F. Weiner, MD · Answer

You have significant cheek volume loss. The NLF can't be helped without first correcting the cheeks. Most of the problem with the NLF will be improved with cheek filler. I like to use Lyft or Radiesse for this. I use cannulas for maximum safety and less bruising.

Nasolabial folds filler hasn't worked? Juvederm

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