What's the best way to get rid of my nasolabial folds? Age 42 (photo)

Hello, and thank you for your question. Dermal fillers do a great job at plumping up the skin and reducing the appearance of wrinkles, with a smoother transition between the cheeks and the lower face. Microneedling with RF energy (Profound RF) can provide excellent results too. It triggers the body’s natural healing process to promote collagen production to restore the skin’s natural scaffolding, producing a more youthful appearance.

The best way to determine the right procedure for you is to schedule an in-person consultation with a reputable facial plastic surgeon, particularly one with an extensive experience with injectables. Your surgeon can assess your skin quality and facial profile, recommend the best treatment or combination of treatments, and ensure the best possible results.

When it comes to aging, the most common problem is volume loss and skin laxity/drooping. There are multiple options to fix these aging side-effects. For patients wanting to correct their nasolabial folds, there are surgical and non-surgical options. Based on your photo provided, you could improve this area by adding volume to it by using an injectable filler (Juvederm/Radiesse/etc.) or undergoing facial fat transfer. The fat transfer option would be more permanent/long-term whereas injectable fillers may last between 6-18 months. The fat transfer allows you to use your body's own fat that has been harvested, processed and injected into the nasolabial fold region. It is important to find a provider who is qualified and knowledgeable in this procedure to ensure best results. Your physician should do a full facial evaluation, understand your goals, and provide the best treatment plan to get to your desired results.

Although there are many alternatives for improving nasolabial folds, there is no true way to completely eliminate all types of nasolabial folds. If one has sharply etched wrinkles, usually the course of action is to improve or eliminate with fillers. However, a lot of people have in addition to the wrinkle, overlying redundant skin. This is much more difficult to treat. A standard facelift will help improve this although this is most noted on the lower part of the nasolabial fold but rarely will a standard facelift fully eliminate redundant skin. Similarly, mid facelifts are difficult. There is no reproducible technique with midface lifting to fully eliminate the redundant skin that some have. There is also more visible scarring with these techniques as often the scar line is placed on the hairline. Other techniques have been tried including direct excision of the fold itself in replacing all the redundant skin with a scar line. This is definitely not for everybody. A good consultation with your plastic surgeon can help guide you through the various options.

There are several options including a standard cheeklift to tighten cheek skin towards the ears, along with conservative liposuction to reduce the fat fullness in the upper jowl area just behind the folds. A more direct and less extensive surgery is the direct excision (removal) of a long ellipse of skin and fat along each fold, but that does leave a scar within the NLF, although the scar is camouflaged by the crease and the skin/fat removal flattens the area quite nicely. Alternatively, a non-surgical approach is just to inject fillers into the depth of each fold to plump up the fold and thereby make it less distinct and less noticeable.

Currently the most frequent procedure to improve this condition is injection of fillers. In some cases, with very deep folds, direct excision is recommended; scars are usually less visible than deep groove/folds. Hope this helps.

A facelift would do very little to
Improve those folds. You can try injectable fillers. If they were worse they could be improved by direct excision but typically in older patients

Fat grafting using your own fat is possible. I personally try to avoid hyaluronic acid fillers in most cases.
If there is skin laxity and you like the way it looks when elevated back/up with your fingers, then a lifting procedure may be necessary.
I perform many male face and neck lifts and the incisions heal very well in most patients. You are young - but there is no set age to determine when a facelift is warranted and it is a decision you must make with your surgeon.

Thanks for your question! If you are only bothered by your nasolabial folds, you could try fillers to help reduce the appearance. Good luck!

Dear Exuberant864183,
Thanks for sharing your photo. It illustrates the beginnings of skin laxity associated with volume loss in the cheeks and collagen reduction of the skin and soft tissues underneath it. These 2 mechanisms allow the skin to fall centrally and curl in at its attachments at the brow, nasojugal, nasolabial, lip commisure and marrionette folds. When the dermal layer wrinkles, you've got a crease.
Currently, there are 3 general options in rejuvenation:
A. Non-Surgical: collagen stimulation with retinoids and tighening with chemical peels
B. Minimally Invasive: injectables such as: 1) Hyaluronic acid to fill the crease and soften the fold. 2) Sculptra to stimulate collagen/elastin and other structural molecules to firm and fill the line and fold. 3) ThreadLift using a barbed collagen stimulating suture to redrape the fold upwardly maintaining its position with the above skin tightening and collagen stimulating techniques. 4) cheek fillers to expand the volume loss tugging the fold upwardly.
C. Surgical facelift to replace the sagging jowl up to the cheek for volume and redraping the skin supero-laterally.
Each has its pro's and con's. Consult with a talented and experienced Board Certified Plastic Surgeon to evaluate your desires, budget, downtime etc. All the best!