Nasolabial folds appeared after subcision + RF microneedling — is there anything that can safely improve this? (Photos)

Question

I had TL subcision combined with RF microneedling about 2.5 years ago. I believe i did not need this procedure as my scarring was shallow on one side with only 3-4 moderate scars on the other. Before the procedure, I didn’t have visible nasolabial folds. After healing, I noticed new lines and volume loss in my mid cheek. I’ve attached photos showing the change. Can you help me understand what might have caused this? Could the subcision or structural shift from the procedure have contributed? And is there anything that can safely improve this without making it worse?

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. The changes you’re seeing—new nasolabial folds and mid-cheek volume loss after TL subcision and RF microneedling—are likely due to structural shifts caused by the procedure itself. Subcision can disrupt fat compartments or create internal scarring, especially if done too aggressively or in areas with minimal need, while RF microneedling may contribute to fat atrophy due to its heat-based mechanism. Together, they may have altered the support and volume in your midface, leading to a hollowed or aged appearance that wasn’t present before. This is particularly common in lean individuals or those with subtle scarring who undergo deeper treatments. To safely improve this without making it worse, options like biostimulatory fillers, such as Sculptra or diluted Radiesse, can help restore volume and collagen gradually without the risks associated with traditional HA fillers in this context. I hope this helps and best of luck!

Nelson Lee Novick, MD · Answer

For full cheek or temple subcisions, I prefer Field Subcision, a term that I coined many years ago for a non-aggressive subcision that covers a wide area, such as the cheeks or temples or lower face. Taylor Liberator Subcisions, on the other hand, tend to be very aggressive, destructive procedures that may result in excess fibrous scar tissue under the skin, which can manifest as troubling lumps under the skin, and/or  bumps and nodules projecting above the skin surface, (which does not seem to be the case here), for which I have developed a treatment algorithm consisting of the intralesional injection of varying combinations, concentrations and amounts of anti-inflammatory agents. 
 Microneedling is not a particularly useful monotherapy for treating acne scars, but is quite useful for treating very superficial, skin surface color and textural issues. I have been performing manual mechanical microneedling for over a quarter of a century. However, I do not use RF microneedling, however, since this increases the expense of treatment, as well as increases the risks for adverse reactions, such as heat-related atrophy, which may be the basis for the cheek sinking and smile folds that disturb you. 
Happily, the volume loss can be restored with the use of an appropriately robust HA filler in the hands of an experieinced, board certified cosmetic dermatologist filler expert. Hope this helps, and best of luck.

Nasolabial folds appeared after subcision + RF microneedling — is there anything that can safely improve this? (Photos)

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Nasolabial folds appeared after subcision + RF microneedling — is there anything that can safely improve this? (Photos)

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Everything you need to know about Subcision

Our mission is to create a world where every investment in modern beauty is Worth It.