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
