Avoiding "monkey face" with fillers? Where should I be injected? (photo)

Question

Wondering wheres the best spot to inject to smooth out nasolabial lines and marionette lines? I've heard some inject the cheek area and NOT directly in the lines to avoid a "monkey" look? I want to smooth out my face without looking puffy or bigger. I dont have much fat in my cheeks which probably makes it lool worse. How do you avoid hitting any arteries ? There are so many next to your nose and cheek so that scares me a little too! Which type of filler is best used and can it also be used under eyes?

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. To address nasolabial and marionette lines while maintaining a natural, non-puffy look, the key is to inject strategically, not directly into the lines themselves. Injecting in the cheek area—specifically in the mid-face—can help to lift and smooth these lines by restoring volume in the regions that naturally lose fat with age. This technique avoids overfilling the lines themselves, which can lead to a "puffy" or unnatural appearance, often referred to as the "monkey look." The goal is to enhance the cheekbone area and provide subtle volume where it’s most needed, which naturally lifts and softens the nasolabial and marionette lines without making your face look fuller than it should. To avoid hitting any arteries, experienced injectors use careful anatomical knowledge and advanced techniques, such as using a cannula instead of a needle, which significantly reduces the risk of bruising or hitting a blood vessel. I hope this helps and best of luck!

Anna Chacon, MD, FAAD · Answer

our concerns are valid, and it's important to approach filler treatments with both precision and care.

Injection Sites: To avoid the "monkey face" or overfilled appearance, many practitioners focus on injecting fillers into the mid-cheek area rather than directly into the nasolabial folds and marionette lines. By enhancing the volume in the cheeks, the lines can appear softer and more natural. This technique helps maintain a balanced facial contour.

Avoiding Arteries: It's crucial to have injections performed by an experienced professional who is knowledgeable about facial anatomy. They will use techniques such as aspiration and slow injection to minimize the risk of vascular complications. Ultrasound-guided injections are becoming more popular for added safety.

Type of Filler: Hyaluronic acid fillers like Juvederm and Restylane are commonly used for these areas because they are versatile and can be dissolved if needed. These fillers can also be used under the eyes to address tear troughs, though it requires a skilled injector to avoid complications such as puffiness or a bluish tint.

I recommend consulting with a board-certified dermatologist or plastic surgeon who specializes in facial aesthetics. They can provide a personalized assessment and recommend the best approach to achieve your desired look safely.

Jonghyun Hong, MD · Answer

Hello, this is Dr. Hong from Fresh Clinic in Seoul, South Korea.
You've made a very good observation. Based on the photo, it appears that you have relatively little fat in your cheeks, which makes the nasolabial folds look more pronounced.
To improve this area naturally, I would recommend adding a bit of volume to the apple of your cheeks. This will help lift the mid-face and reduce the appearance of the folds. In addition, a small amount of filler directly into the nasolabial folds, combined with skin Botox, can help soften the lines while improving skin elasticity.
Since the folds are already visible, a combination of volume restoration and skin quality improvement is needed to achieve a smoother look.
What I strongly do not recommend in your case are collagen stimulators like Sculptra or Juvelook. These are not ideal for your specific concerns.Alternative to the filler can be Fat Transfer, but not collagen stimulators. 
I hope this helps clarify things for you!
Warm regards,Dr. Hong

Michael A. Persky, MD · Answer

Hi Danielle,
You have a pretty face that needs very little correction.  You are correct, directly filling your nasolabial folds is not the best approach.  Loss of bony volume in your face results in lack of support causing your early nasolabial folds.  You would benefit from evaluation by an expert physician followed by appropriate treatment to help you achieve your aesthetic goals,  I would either use an injection on your cheek bone or a foundational initial treatment with Sculptra for overall facial bioregeneration.  Choosing an expert physician injector is most important in avoidance of vascular or other complications.  Feel free to contact me to schedule either an in person or virtual consultation to help decide your best treatment plan.  Good luck and be well.
Michael A. Persky, MD
Encino, CA

Camille Cash, MD · Answer

It is important to begin with an experienced injector for your treatment.  Ask to see before/after photos of other patients and discuss your goals for treatment as well as concerns.  There are different fillers available that are designed for specific areas.  For example Restylane Lyft is great for the cheek area and Juvederm Volux is great for the jawline.  I've included a video I hope you find helpful.

Sangita C. Patel, MD · Answer

For the above I would inject deep, just above the mid to upper outer cheekbone. This will lift the skin envelope and minimize the NLF and can elevate the undereye skin without injecting the undereye area. I pair this type of Voluma filler injection with endolaser lifting (subsurface laser skin tightening) if there is significant skin laxity. For above, filler is all that is needed.

Avoiding "monkey face" with fillers? Where should I be injected? (photo)

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