What would be the best treatment for my nasolabial folds? Fillers, tretinoin? (Photo)

Hi, Good question. SURGERY- At age 29, your face, jawline and neck are not sagging, so surgical facelift is out of the question. In fact, one of the original “improvements” to the standard SMAS facelift was the Deep Plane facelift by Dr. Sam Hamra. The idea was to go deep under the SMAS and release the cheek fat pad under the orbicularis to pull the cheek fat pad up in and upwards and diagonal direction. If you pull up and out on your cheek prominence you will note that shadow by the side of the nose disappears and the nasolabial fold also improves. It may not eliminate the actual fine wrinkle, but you will notice an improvement. However, in 2002 Dr. Hamra wrote a follow up medical article in PRS entitled: A study of the long-term effect of malar fat repositioning in face lift surgery: short-term success but long-term failure. The conclusion stated: “ The results confirmed that repositioning of the SMAS remained for longer than improvement in the nasolabial fold and that the vertical diameter of the periorbit did not change at all. The early results of malar fat repositioning shown at 1 to 2 years were successful, but the long-term results showed failure of the early improvement, manifested by recurrence of the nasolabial folds.” This lack of improvement after 1-2 years is with the “gold standard” facelift, let alone dissolveable thread lifts which can also show a temporary improvement. For this reason, I have changed my nasolabial fold strategy to primarily focusing on reducing the shadow by the side of the nose (AKA paranasal fold). There are silicone paranasal fold implants which help, but often times the patients may ask to have them removed due to its rigidity and perhaps some issues they may have when they smile. FILLERS- A non-surgical option is to fill the paranasal fold area with a firmer filler which can mimic the paranasal fold implant, but have some softness when they smile. The injector needs to have good technique and be very aware than there are large vessels in the area to avoid injection into (intravascular injection, which is very bad and has serious consequences.) TRETINOIN- tretinoin or Retin-A is a prescription retinol. It is a vitamin A based and helps program the skin to turn over faster and produce more extra cellular matrix which we want our skin to make more natural hyaluronic acid, this will help with fine lines and wrinkles, so it may help a little bit with the line/wrinkle itself, but your expectations need to be realistic. It won’t help to fill in the paranasal fold area, since there is probably fat loss due to losing our baby fat as we age from 15 to 29. When we are younger, our cheek fat extends right to the sides of our nose and the cheek wraps around the nose tightly. Yet when you smile as a teenager, you can still make a normal looking smile lines. Hope this covers all of your questions and provided some value. Good luck. Best, Dr. Yang

Hi @Sincere9280! Dermal fillers can help smoothen out the nasolabial folds. You can also try Morpheus 8. Morpheus8 is a non-surgical treatment for full body skin resurfacing, skin tightening, and fat reduction of stubborn areas. It uses minimally invasive fractional radiofrequency energy (RF) to penetrate the skin deeper than other microneedling devices, triggering the skin’s natural healing response to promote skin tightening and lifting.

Hello, and thank you for providing a photo along with your question. Based on the image, it appears your folds may be addressed using non-surgical skin rejuvenating procedures (although a proper skin evaluation is a must). For instance, you may try injectables. Dermal fillers can lessen the appearance of nasolabial folds by plumping the upper cheek or the area just below your smile lines.

If your folds are caused by a tight muscle, you may benefit from Botox injections. Sometimes, a combination of neuromodulators and dermal fillers will achieve the best results. To determine the best procedure(s) for you, I recommend scheduling an in-person consultation with a reputable injector who has extensive experience in all types of injectables. Your provider can properly assess your skin folds, determine the ideal treatment or combination of treatments for you, and ensure the best possible results.

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

Dear Sincere9280,
There are a few different things you can do to make NLF better. Hyaluronic Acid Filler is one of the easiest and most immediate ways to smooth out NLF. And it is reversible. Other dermal fillers can also work. Alternatively, you can try some tightening devices, such as radiofrequency treatments or high intensity ultrasound treatments.
It is important to understand that NLF is not a fine line. It is a fold that is created with tissue laxity, where tissue above hovers over the natural ligaments. Therefore, while skin care like that of tretinoin will improve skin quality but because of the little effect it has on laxity of the deep tissue, topical skin care is going to be limited on treating NLF.

Fillers strategically placed in your cheeks, near your nose, and a bit in your nasolabial folds would definitely help diminish the appearance of those folds. Another option would be Sculptra, an injectable treatment that gradually helps to restore lost volume wherever it's injected. Sculptra is a wonderful treatment option for overall facial rejuvenation and for preventing the signs of aging!

Fillers work great to lessen the appearance of nasolabial folds. The treatment is done in the office with final results seen after 14 days. The effects will gradually wear off over approximately one year. We also recommend using medical grade skin care products and wearing sunscreen every day.

Dear Sincere, I would put some filler in your cheeks . That would fill and round them nicely and raise up your nasolabial fold. Some people will put a little in NLF as well, if needed. You do not want surgery and you do not want to put fillers in NLF only. That is not the correct way to fix this.