33 years old - best treatment for deep nasolabial folds? (Photos)

Question

Hi everyone, I'm 33 years old and have always had fairly deep nasolabial folds, even as a teenager, but I've noticed they've become significantly more pronounced over the last 12 months. I'm feeling increasingly self-conscious about them and am trying to understand what treatment options might be most appropriate. I've been researching filler, fat grafting, and mid-face facelift procedures, but I'm struggling to determine which approach would provide the most natural and long-lasting improvement. What treatments would you recommend, and what should I ask a surgeon to help identify the cause of my folds? I would appreciate any advice or guidance. Thank you!

David Hill, MD · Answer

If you want to see how this would look, the easiest fast and reversible option is hyaluronic acid filler. If you like the look you can do fat grafting to the area (pyriform fossa), which is one of the best longterm natural solutions. If you have other skin laxity or want fuller cheeks a midface lift would also work, but given your age and skin quality this is likely overkill/premature.

Gary M. Horndeski, MD · Answer

Your upper lip is quite thin and you have developed some marionette deformities. An alternative to consider is an eccentric lip lift, not a bullhorn lip lift. This does 4 things: shortens the distance between your nose and upper lip, increases the mucosa of the upper lip, increases the incisor show and pulls up the corners. This will also help mask the marionette deformities and nasolabial folds. This takes 1 hour to perform under local anesthesia and costs $4,000.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Nelson Lee Novick, MD · Answer

At least from the photos provided, there appears to be some volume deficit in the upper cheeks, as evidenced by the apparent deflation of the the transitional region between the upper cheeks and the under-eye regions. And, since the upper cheeks provide lift for the cheeks below, loss of volume there, for any reason, typically results in the appearance and/or accentuation of the smile folds. 
So, the use of a robust HA lifting filling, can address this problem (usually takes about ten minutes tops to treat in the hands of an experienced injector) and simultaneously restore a smooth transition between the upper cheeks and under-eyes AND address the smile folds. The results are typically immediate and there is usually little to no significant downtime. Hope this helps and best of luck.

Mike Majmundar, MD · Answer

Based on the photographs, it appears you have more volume support loss than loose skin. Adding volume using fat or filler would be helpful to improve the majority of your concerns.  If you are against adding more volume to your face, you can consider a deep plane facelift to lift your cheek tissues and reposition them back upwards but I think you’ll still need some form of volume support.  At your age, trying filler first makes the most sense.  Adding carefully placed filler under the eyes and into the midface and lastly into the nasolabial folds will give you the biggest improvement.   Good Luck.

33 years old - best treatment for deep nasolabial folds? (Photos)

Answers (4)

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