Nasolabial fold Botox, filler or buccal pad removal? (Photo)

I've always been bothered by the roundness of my cheeks, which when I smile makes a deep vertical fold from nose to mouth for a 'chipmunk' smile. My face is rather thin when not smiling and at past 30 I don't want to end up with hollow cheeks when I've been naturally 'blessed' with a fuller face... But i wondered if there is simple solution to reducing the deepness of the fold when I smile so the cheeks appear smaller/ more defined? Any advice much appreciated.

Doctor Answers 12

Selecting a treatment for nasolabial folds when smiling.

There are so many wonderful treatment options available to improve the appearance of one's face. When choosing one the first priority is safety. The second priority is selecting the correct treatment for the right indication.

Botox and other neuromodulators are great for muscles that cause wrinkles, particularly around the eyes. Around the mouth, the muscle groups are so complex, it's challenging to get a consistently good outcome. There is even potential to give you a lop-sided or unnatural smile. 

Fillers are great for wrinkles that you see at rest, particularly in the nasolabial fold area. However if there are no wrinkles at rest, then fillers won't help. They may even create too much volume that bunches up when you smile.

In my humble opinion, when you have a beautiful smile, with no nasolabial lines at rest, and natural facial volume, take confidence in the fact that there are many other people who envy your youthful features. 



San Diego Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Treatment of nasolabial folds

Thank you for your question. I would avoid using a lot of filler to the nasolabial folds. You don't have any creases when you aren't smiling. It is normal and attractive to have lines while smiling. Possibly a bit of filler at the most medial/proximal aspect of the nasolabial fold. 

I hope this helps.

- Dr. Bryson Richards

Botox vs fillers vs fat removal

Thank you for your question and photo.   When you are not smiling, you have no significant lines.  With smiling (or what we call animation) you have lines.  This is obviously normal.  You have a very nice youthful face.  I would not change much of anything. Botox paralyzes muscles so they can't move--not a good option for this part of the face--you will not be able to smile (or more often will have a crooked smile).  Buccal fat removal is not a good option--will leave your cheeks hollowed out.  Filler is an option, but will not significantly change your smile when animated.  

Brian C. Reuben, MD
Salt Lake City Plastic Surgeon
5.0 out of 5 stars 30 reviews

Nasolabial fold Botox, filler or buccal pad removal? Dr. Shah says do nothing!

Hello gettingreal1983,
Thanks for your question.
As you have no nasolabial folds at rest, there is probably little you should do at this point.  Adding filler to the nasolabial fold will increase the width of your cheeks and take away normal facial contours making you look very doughy and puffy.
You have no indication for Botox here or for buccal fat pad removal at this time.
Your face looks normal, so anything you do to it now will make it look abnormal.
Good luck,
Dr. Shah

Manish H. Shah, MD, FACS
Denver Plastic Surgeon
4.8 out of 5 stars 47 reviews

Smile Lines

I would definitely suggest you looking into a filler such as Voluma for the cheeks to decrease the nasolabial area.  Botox injections around the masseter muscle will help a great deal as well. Thermage will tighten the jowls and also help a great deal with the folds. Please consult an expert for the best results.  Best, Dr. Green

Treatment to my nasal labial folds?

Everyone has something they don't like when they look in the mirror, but that doesn't necessarily mean that it is a bad thing or something you should correct.  With that said, the lines you see when you smile are perfectly normal.  You do not have any lines when you are at rest.  There is nothing you should do to the nasal labial folds.  You look good and everything you see is normal.  I wouldn't recommend anything for you.  

Elena Vega, DO
New York General Surgeon
5.0 out of 5 stars 2 reviews

How to treat nasolabial folds (smile lines)

Thank you for sharing your question and photos. You have a pretty smile and probably should not have any procedures. If you feel you have to try something, then only consider a bit of filler.
Good luck,

Nasolabial fold Botox, filler or buccal pad removal?

Though I see wonderful results from buccal fat pad removal, you are not a candidate for it.  Same with Botox or Xeomin (they don't help the n/l fold).  The only thing that I would consider as a trial for you would be placement of some filler relatively superficially to slightly soften the furrow during smiling.  You can't get rid of it with filler without leaving swollen lines when you're not smiling, but you might succeed in softening it somewhat.

Jon A Perlman MD FACS
Certified, Am Board of Plastic Surgery
Extreme Makeover Surgeon ABC TV
Beverly Hills, Ca

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 30 reviews

Deep folds with smiling

Deep folds with smiling are normal. In repose, you folds appear very soft. Botox is not a good choice. Fillers will not likely improve your appearance with animation.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Nasolabial fold

You have no fold at rest. There is no indication for treatment with a filler as your fold is normal and appears when you smile just as it does in every other person.

Edwin Ishoo, MD
Cambridge Facial Plastic Surgeon
4.4 out of 5 stars 20 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.