34 y/o, what are my options to soften the appearance of nasolabial folds? Trying to avoid filler (photo)

A cheek lift (which can be performed under local anesthesia) is probably your best option (though an in person or remote consultation is important to be sure). We have performed these for at least 30 years, and the results last 7-15 years. Long lasting fillers have complications (granulomas, sculptomas, lumps). HA fillers are a good option, but need to be repeated in 6 months to a year.

I view the cheek as a "periocular" area. I can't tell from your picture if your lower eyelids are a factor. An in-person or a remote evaluation is essential. We have a "smile" test, which gives more information. The mid-face is one of the first areas that our eye catches to discern a "tired" appearance.

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

Subcision, which I have been performing routinely since 1995, is a simple and relatively inexpensive method for elevating and smoothing all kinds of skin indentations from scars to wrinkles and folds. It does not require any filler and the result are long-lasting to permanent. I gave up threadlifting several years ago. It has an unacceptably high rate of adverse reactions, including infections,skin dimpling and puckering and "spitting out" of stitches. It also does not address volume deficit. That being said, there appears in the photo to be a volume deficit in the cheeks, which is largely responsible for the deepening of the smile lines, as well as for the creation of less heart-shaped, oval appearance to the face; lack of volume there is also largely responsible for the development of the incipient bags noted below the eyes. So, unless there is some contraindication for the use of fillers, the use of a robust HA filler for the cheeks properly performed in experienced hands would go a long way to mitigating all of the foregoing. You would be wise to consult with a board certified cosmetic dermatologist to discuss these issues and best of luck.

Hello laurateresax! My name is Jessica, I am a physician assistant, and one of the providers at Shah Facial Plastics. I understand your concerns and that you are not interested in fillers. You can consider other treatments such as Morpheus8. This is a radiofrequency treatment that is combined with microneedling that helps to promote collagen production, tighten the skin, minimize the appearance of pores, and improve skin tone and texture. I hope this helps!

Options can include both non-surgical and surgical procedures. While you mentioned not wanting traditional fillers, there are different types available, such as permanent ones that don't migrate, and when administered by skilled professionals, they can yield natural-looking results. Other possibilities for addressing nasolabial folds include Renuva (stimulates fat production), fat transfer, lifting threads, or laser treatments. For more comprehensive results, a facelift could be considered. However, it's essential to have an in-person examination to evaluate your skin elasticity and structure accurately and determine the most suitable course of action.

Best of luck!

Nice 1 posted photo. Might offer nano/micro fat grafts to NL folds with anterior mini/temple lift with SMAS plication. Fee from $10,000. Best to virtual consult with....

you have a fairly standard combo of early eye bags, tear trough and mid facial descent. this is typical in mid 30 to wary 40s
filler is a disguise like make up for this problem. some mid face lifting technique or in an early stage so mid facial volume will help. this is a progressive problem as is ageing and so will merit a more definitive surgical option eventually.
Adam Goodwin