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

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!

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.

I’m going to assume that the abbreviation TL stands for a thread lift.
If the thread lift ended up putting tension on your SMAS layer and tightening this can deepen nasolabial it’s the same reason why defaults are sometimes made worse by having a facelift that includes tightening of the SMAS layer.
Fillers is the treatment of choice for nasolabial folds.
Insufficient, skeletal bone structure of the lower face can create a predisposition for premature soft tissue aging.
I suggest having a few in person consultations with plastic surgeons in your community.
Best,
Mats Hagstrom MD