How much restalyne would I need to lift the mid face? (photos)

Question

I recently had 1 cc of restalyne into my nasiolabial folds and didn't notice any difference. I do have cheek sagging, mostly on one side. I feel I look 10 years older then I am and have only noticed the sagging in the past 2 years suddenly. How did 1cc not make a difference and how much would realistically be needed?

Stephen T. Greenberg, MD, FACS · Answer

Thank you for your question.  Looking at the photo's you have provided I would recommend a total of 4 syringes to start off with.  There are different fillers for different area's.  I personally like to use Restylane Contour to help build the cheek area up.  It's a longer lasting filler and typically 1-2 cc's are required.  For the NLF area and marionette lines I would recommend 3cc's of Restylane Refyne.  Fillers are only as good as what we use meaning 1cc isn't a lot of filler.  I would suggest seeing a Board Certified Injector
 ( Plastic Surgeon or Dermatologist) in person for a evaluation.  Best of luck to you.

John Diaz, MD · Answer

One syringe of filler equates to the size of a blueberry when injected. You will most likely need three to four syringes to achieve the desired outcome. It is important to treat the midface area (cheeks) first, as this is where the majority of volume loss occurs.

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Nima Shemirani, MD · Answer

Hi @hfreed3589! 1 cc of filler is equivalent to a blueberry. I would recommend adding at least 1 syringe of filler to each cheek. With this lift, your nasolabial folds will look softer. In addition, I recommend Morpheus 8. Morpheus8 is a non-surgical advanced radiofequency microneedling treatment. Morpheus 8  stimulates collagen production to tighten and smooth wrinkles on the face.

Nelson Lee Novick, MD · Answer

The reason that you did not achieve your goals of addressing the sagging in your cheeks is most likely related related to three factors: inappropriate location of treatment, the choice of a filler not robust enough to get the job done, and the use of way too little. The sagging of the cheeks and the deep smile and marionette lines are actually due to volume loss in the cheeks. The use of an appropriately robust HA filler intended for this location and in an appropriate amount (one syringe would unlikely due much in the first place and certainly not if used to directly in the smile lines to "chase after the folds.") The "liquid facelift" you are seeking would likely be achieved if the cheeks are treated with appropriate amounts of a robust HA volumizing filler, such as Voluma XC or Resytlane Lyft (and not ordinary Restylane or plain Juvederm, which are best reserved for treating fine lines_). You would be wise to make sure to consult an experienced, board certified cosmetic dermatologist, since your goals are generally quite easily achieved with the appropriate fillers in the proper amounts.

Amir Mortazavi, MD · Answer

Thank you for the question and the images. IN regards to the nasolabial fold it can likely be due to the type of filler used but in most cases when moderate to severe you will likely need 2 syringes for nasolabial fold alone. You can also get a good result by improving the midface that can indirectly improve the nasolabial folds. Based on the the pictures you should get a good result with 2 or 3 syringes in the hands of a experienced provider.

Dean P. Kane, MD, FACS · Answer

Dear hfreed3589, 
Thanks for sharing your photos. Skin and underlying fat laxity, cheek sagging, folds and wrinkles occurs with facial aging from collagen loss. There are many ways to improve your concerns but it takes a in-person evaluation from an experienced, Board Certified Plastic Surgeon skilled in non-surgical, minimally invasive and surgical options to achieve your goals. The tissues of the body are layered and respond differently to the fillers injected into them. 1 cc of Restylane may soften lines or wrinkles but will not fill, project and expand the cheeks to smoothen overlying folds. This will take more volume with different characteristics under deeper layers of the “mid-face”. Consider: 
•	Non-surgical: tretinoin (retinoids) for skin tightening, color evening, wrinkle repair and skin turnover
•	Minimally invasive: hyaluronic acid fillers chosen for the goals you wish to achieve and / or fat grafting; PDO thread lift and Sculptra
I hope this helps. All the best!

Camille Cash, MD · Answer

The amount of filler recommended will vary by patient and area treated.  One rule of thumb that may be used is 1cc (one syringe) for every 10 years of age.  One syringe of filler was just too little for you to achieve the result you are wanting.  The great thing about fillers is that you can go slowly and build up to your goal.

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you very much for your question.  Injecting Restylane in the nasolabial fold in my experience does little to achieve a good result.

The problem that is causing deepening of the nasolabial fold is loss of volume in the mid face or the cheeks.

To make the face look younger and fuller I inject 1 cc of Restylane lift into each midface starting on the zygoma or the cheekbone and placing small amounts medially towards the nose.

Properly done the result is very noticeable and makes the face look much younger and fuller as well as lessen the severity of the nasolabial fold.

Cheek or midface Restylane lift is my choice for correcting nasolabial folds and facial aging.

Reuel Aspacio, MD, FAAD - Account Suspended · Answer

Hi there,

Realistically probably about 6 syringes. You need filler mid face and jawline along with the marionette and nasal labial folds.  You need to address volume loss that's happening all over not and not just chasing lines.  Also consider a few laser treatments such as the Clear and Brilliant.  That will help with the dark spots and tighten a bit as well.  See an expert and best of luck!

How much restalyne would I need to lift the mid face? (photos)

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