Nasolabial Folds - Best Way to Remove Them?

Question

Hi : While considering fillers for removing the naso labial folds ( very mild) what is the best technique ? Fill the folds or use fillers on the cheeks to lift it ? I have high cheek bones already and i am aftraid I may look over dobe. And also this will be first time I am considering fillers. Is it good to start with Juvederm then Perlane ? I am very familiar with all the fillers and have done enogh reading over the past few months.

Brent Moelleken, MD · Answer

It is often not a good idea to remove nasolabial folds completely, by any method.  It is usually better to soften them.  If the nasolabial folds are "build up" to the level of the ptotic cheekpad above them, or the lip below them, this can result in an overaugmented appearance, as though the patient had something in their mouth.

	If the nasolabial area is augmented, the cheek area (malar, possibly submalar) regions may benefit from volume augmentation as well, in order to prevent a disproportion from occurring.

	For mild nasolabial folds, hyaluronic acid fillers are usually adequate.

	For deeper lines, the patient may want to address what is causing the folds.  Sometimes, this means a volume adjusting facelift, a cheeklift, or both.  Volume alone can't overcome drooping plus volume loss.

	Large volume augmentation of the face is possible.  The" liquid facelift", large amounts of temporary filler, offers a quick recovery, but expensive and temporary, fix.

	Fat injection is a popular option as well to multiple areas of the face.

	In our practice, we prefer autologous fat fascial grafts for this purpose (LiveFill).

	In rare patients, excision of the nasolabial folds is an option.

	So in deciding which option to choose, it is nice if your doctor is familiar and skilled with all of the options above, and understands the proportions of the face.

Nima Shemirani, MD · Answer

Hi @8083anon. I would suggest you consider hyaluronic acid dermal fillers like Restylane Defyne for your nasolabial folds/laugh lines. I recommend seeking treatments from expert injectors who have the skill and experience to precisely inject fillers into treatment areas and avoid risks and complications. Best of luck, Dr. Nima!

David Hansen, MD · Answer

If the NL lines are just thin lines then juvederm or restylane ($550/syringe) is good and lasts about 4-6 months.  If the NL has grooves or wider, deeper creases then Radiesse ($600/syringe) is great and lasts about 1 yr.  Most patients need 2 syringes to do either  job.  Sincerely,  

	David Hansen,MD

Bernard Salameh, MD, FACS · Answer

Thank you for your question. In my opinion, fillers work very well for improving nasolabial folds. Nasolabial folds can be secondary to cheek descent and by adding volume to the cheeks the folds will improve and then any residual folds can be improved with fillers. For natural results, I would recommend to soften the folds and not fully remove them.
I hope this helps. Best wishes. Dr. Salameh (Plastic surgeon - Bowling Green, KY)

Aaron Stone, MD · Answer

Without photos or a face to face examination I cannot say what would be best in your case. Prior to the advent of dermal fillers facelifts were recommended to lift the cheek fat so it would not hang over the nasolabial folds. The problem was this made them look better but did not efface the very deep folds enough. This led to the use of fat grafts to the area placed at the time of facelift surgery. Now we have dermal fillers and this has saved many patients from surgery with its associated higher costs. The current standard is to inject filler directly into the fold to efface or fill it. Every doctor has his or her favorite way to inject and favorite filler to inject. I prefer Radiesse in the nasolabial folds because it lasts longer than most other dermal fillers. Patients like this because they then do not have to come back so often and it is cheaper over the long term.

Steven Wallach, MD · Answer

Placing fillers in the nasolabial folds will help soften a bit. You do not want them to disappear completely because that would look strange. And yes, sometimes lifting the cheeks a bit with fillers or surgery will soften them as well.

Nasolabial Folds - Best Way to Remove Them?

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