I had Juvederm injected today to soften my laugh lines. There was sagging cheek tissue above them, which bothered me. The doctor injected the filler ABOVE the crease, not in it, even though I expressed that I wanted more volume in the crease & in my upper cheeks. My actual parenthesis lines dont look much softer, but I fear this sagging ridge above them looks more pronounced as it is now filled, & my cheek bones look lower. He assured me this is how it is done?
Juvederm Injected ABOVE Crease?
Doctor Answers 12
Juvederm mistake can be corrected
If this is truly the care, it is most likely an error in medical judgment. It is correctable. One must first dissolve the filler using hyaluronidase placed expertly within the mis-placed filler. Then, your physician can inject the filler into the more appropriate area.
Juvederm for laugh lines
Wait 2 weeks and if you are not happy with your results, return to your doctor for assessment. Ask him what his recommendations would be and if you do not think it is right for you, consider seeing another doctor, preferable a dermatologist or plastic surgeon, for another opinion.
Where to inject Juvederm
Without before and after pictures, we care unable to give you specific advice. However, the nasolabial crease and fold are caused by two issues. First, anatomic attachments under the skin which cause a "crease." Second, loss of volume in the cheek which causes loose skin to fold over the crease and make a "fold." So, the treatment is two-part. First, injecting some filler under the crease to help push it out and, second, injecting filler in the cheek to help fill up the loose skin. Every patient is different and the treatment needs to be customized to their specific anatomy. If you have concerns with your treatment, then it is best that you discuss your concerns with the doctor that injected you. However, everyone must also understand that fillers soften the folds, but will not make them go away completely.
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Juvederm and smile creases
Formerly, when only the smile creases were injected, they would be injected right underneath them or slightly to the inner aspect (closer to the midline of the face) to lift them up. In the last decade we have learned that cheek augmentation is better to help support the loose tissue that falls over the crease and makes the smile line more obvious. Fillers are done by experts, but every expert has a different approach and touch. There is some art related to this sculpting. Juvederm can be dissolved with hyaluronidase if you don't want to deal with your result until it vanishes on its own. You can see my technique for injecting Restylane, similar to Juvederm, in the attached video.
Juvederm to fill in parenthesis.
The difficulty here is that there are many ways to use Juvederm to fill in the nasolabial folds and only your surgeon, MD knows which technique he/she used and where the filler was placed. These fillers give instant results, so if you feel it was placed somewhere in the face, you're most likely correct and in that case I suggest you go back and discuss this with the MD. Perhaps you can have additional filler placed into the nasolabial folds to fill those out.
Placement of Juvederm
Unfortunately, without seeing a picture of you before the injections it would be difficult to say what your physician's thinking process may have been. Often times it isn't the nasolabial folds that represent the problem it is in fact a hollowing just lateral to the folds and upper cheek area that make the folds appear more pronounced. In these cases I can totally understand injecting laterally and addressing the cheeks as well..it can make a world of difference....more often than not though in these cases one syringe is not sufficient to provide the volume necessary. Some injectors, unfortunately, do just miss the mark so to speak and fill the wrong or inappropriate areas. We've seen this in many cases as well. If you are unhappy with the results the great news about Juvederm is that it can be dissolved with Hyaluronidase and will disappear almost immediately and a few days later you can start again from scratch, perhaps with a different provider.
Hope this helps
Dr. Grant Stevens
JUVEDERM INJECTED ABOVE CREASE
You may have needed more than one syringe injected to start with.
It is possible that your sagging cheeks can be improved by injecting more Juvederm over the malar bones(deeply, over the periosteum).
This way, your melolabial creases may also be made shallower.
Make sure you have the injections done by an experienced, Board Certified Dermatologist or Plastic Surgeon.
Juvederm Should be Injected INTO the Crease
It is often better to fix the cause of the wrinkle before going after the wrinkle itself. Fixing the "sagging cheek tissue" you describe entails using a volumizing filler such as Sculptra or Radiesse to restore volume to your cheek. They are injected much higher along the cheekbone at "vector points" that provide the greatest lift. The cheek folds can be dramatically improved by injections of the proper fillers below the level of the skin elsewhere in the face. Wrinkle fillers such as Juvederm are made of hyaluronic acid, a natural component of the skin that progressively decreases with age. Juvederm is injected into the wrinkle within the skin at the level of the mid to deep dermis and should not be used to create volume. Hyaluronic acid has the capacity to bind large quantities of water and keeps the skin firm and moisturized. For deep wrinkle lines, using both types of fillers may be the best way to go.
Since every face is different, the experience and technique of your physician injector is the most critical part to your achieving a beautiful, natural result. Always ask about the experience of the injecting physician and make sure they have all of the "tools" to use, such as all of the various facial fillers (Sculptra, Radiesse, Perlane, Restylane, and Juvederm) that are approved for use in the United States.
Where to inject Juvederm to soften parentheses lines
Parentheses lines form because volume is lost from tissues above the nasolabial folds and marionette lines. Volume is lost from soft tissue (mostly collagen), fat and even bone. So facial skin doesn't have the scaffolding it used to have and sags, forming lines, folds and creases below, around the area of the mouth.
In correcting the parentheses, dermal filler can be injected into the lines themselves which would help soften them but also into the cheek areas above that have lost volume. Restoring some of the lost volume results in lifting the skin and softening the folds below.
Usually it is a combination of revolumizing above and into the parentheses that works best.
Correcting NLFs and Midface Volume
I am a bit confused as to what your physician was trying to achieve by injecting the area right above (and parallel to) the nasolabial fold (NLF). A common way to soften a NLF with hyaluronic acid fillers is to inject linear threads directly under the fold proper, and sometimes inferior to it as well. Another injection technique which can be used is to inject linear threads perpendicular to the fold to provide some additional support.
Without visually examining your current appearance, I can’t say what the best solution is for your current problem. But it may involve additional injections, injection of hyaluronidase, or both.
People often think of soft tissue fillers as “line” fillers and do not consider restoring facial volume as a means of correcting the aging process. Restoration of facial volume can often times have a much greater impact on the rejuvenated appearance than merely filling lines. You mention that you have sagging cheek tissue above the NLF. This is a common finding with midface volume loss. Your result could be improved further by using fillers to restore midface volume in addition to addressing the NLF.