Uneven nasolabial lines. What should I do? (Photo)

Question

I got radiesse and Voluma in my cheeks, however I think I need more fillers on my nasolabial lines, they are assymetric when I smile and I also have those marionette lines I can stand... However my doctor says that it could compromise the heart shape of my face. What should I do?

Raffy Karamanoukian, MD, FACS · Answer

Radiesse is a stimulatory filler that is an excellent option for patients who desire a longer-lasting filler alternative to hyaluronic acid dermal fillers. In our office, we use Radiesse to complement structural areas of the face and contour bony prominences. Our office also is a center of excellence for filler complication treatments and we see patients who have been treated by other doctors and have undesirable results from Radiesse or other long-lasting fillers. We have treatment options available for Radiesse filler nodules, granulomas, and soft tissue thickening. The first step would be to diagnose the nodularity and determine whether there is an option for surgical vs. non-surgical removal. Surgical excision is a possibility in some patients; whereas others with more diffuse fillers may benefit from intralesional therapy using scar modulators and enzymes and kenalog. Radiesse complications may be long-lasting and prompt action is key. Patients who have no access to an expert in the field should begin gentle massage of the areas of nodularity with Plato’s Scar Serum twice daily. RF and invasive lasers can actually do more damage by stimulating further collagen growth. 
 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Manjula Jegasothy, MD · Answer

Generally, if you want to have full cheeks, you will have to accept some degree of nasolabial fold, because without that contour difference/indentation, your cheeks would not appear so prominent. It's a trade-off, either one has prominent cheeksand prominent nasolabial folds, or neither.

Michael H. Gold, MD · Answer

As has been pointed out, we are all asymmetric in some shape and form — this is normal. We do not see your before pictures, but having had Voluma and Radiesse, it would make sense that you had some volumizing in your cheeks. The question was how asymmetrical you were before and did this do anything to make it better or was it accentuated — all alluding to injection skill and artistry, which is key anytime you are getting these kinds of injections. A board-certified dermatologist or plastic surgeon should be looking at you, evaluating you and determining with you the most appropriate course moving forward.If there was asymmetry and this is the same now as it was before, more fillers in the cheeks may be necessary, but caution is needed not to overdue in this area. Occasionally a small amount of filler in your right nasolabial fold might "fix" the problem, then some filler in the area around the mouth might correct that as well. Soon we are going to have a new filler – Restylane Silk, FDA cleared for the lips and areas around the mouth. This may be something that might be very helpful for you.Find the right doctor, and they will correct things for you.

Inessa Fishman, MD · Answer

As a baby develops in the womb, his/ her face results from two halves fusing in the middle.  Errors in this development may result in such problems as cleft lip and/ or palate.  This in utero development, genetics, sun exposure, trauma, and a multitude of other factors result in facial asymmetry, which everyone has to some degree.  Injectable treatments are a sculpting process; it is worthwhile to add in small increments, as opposed to overshooting and potentially needing to take away.  Adding product in an asymmetric way to account for underlying present facial asymmetries is part of the art and science of facial injections.  Don't overdo the fillers in the melolabial/ nasolabial folds; overfilling here looks unnatural and may result in the dreaded puffy appearance.  Allow the swelling from the most recent injections subside, and discuss your concerns with your trusted injections provider.

Kris M. Reddy, MD, FACS · Answer

Part of the asymmetry may be anatomical which would not allow for perfect symmetry. Your physician is wise to advise a conservative approach. Allow 2 to 3 months post initial fillers and then assess. At that time juvederm ultra may be a consideration.

Stephen M. Davis, MD, FACS · Answer

Thanks for your question,One thing I tell my patients is that our body is asymmetrical; that includes breasts, buttocks, belly and face.Part of this asymmetry is the bony structures of the facial bones. As a result sometimes one see some degree of difference. At this point I would let the tissues stabilize from the injections and re-evaluate in approximately 6 - 8 weeks. Filler can always be added asymmetrically to help improve differences.I hope this helpsStephen M. Davis, MD, FACSGreen Hills Plastic Surgery

Uneven nasolabial lines. What should I do? (Photo)

Answers (6)

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