Nasolabial folds: horribly deep at only 33! (Photo)

Thank you for your question. You’re 33-years-old, and state you’ve always looked young until the age of 28 when things suddenly changed. You’re concerned about how deep your nasolabial folds are and you feel like you are in your 60s. You’re asking about the number of syringes of fillers needed to make a correction.
I can give you some guidance as to how I approach patients with this type of problem in my practice. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. Dealing with issues with facial volume is a very significant part of my practice. We use a lot of different fillers. I think it’s very important you have a sense of what is a good strategy to address the issues that concern you.
Understanding that the nasolabial folds are deep, when I look at patients who say they have this concern, when you look at yourself, naturally your eyes go toward these folds. There’s no question they have a significant depth. What I would like to point out to my patients is when you step back and you look at the face as a whole, you look at the areas particularly around the eyes and cheekbones, and see how that interfaces with this area where the folds are. In my experience, my people focus in on wrinkles and lines - this is a very significant aspect of aging people find very distressing. One of the things especially in a younger person like yourself where age-related changes are not a significant issue, but rather the genetics of facial fat volume loss, or if you started to exercise aggressively, or change your diet, maybe the volume of your face diminished. If you look at the nasolabial folds in isolation, certainly there is a wide range of options from fillers placed deeply, as well as fillers place superficially.
One great strategy we do in our practice is something called structural volumizing that focuses on the volume loss at the bone level and above the bone level. When you look at your photo and the under eye area at the cheekbone area, there’s a certain degree of flatness. When you think about the understanding of volume loss, the folds and that area in combination contribute to your appearance of looking a little older.
I would recommend a more global approach including the placement of fillers at the structural level and the cheekbone area, the under eye area and the nasolabial folds area- this is where the art of fillers is extremely critical. Yes, you would need a decent amount of syringes. Think about syringes not just in the number of syringes, but the actual volume. The volume of each syringe for a filler like Juvederm or Restylane is about one milliliter. When you think about one milliliter, that’s not a lot. Usually, these fillers provide a fair amount of correction if you’re only treating superficially. When you treat at a deeper level, as is the case in the deeper part of the nasolabial fold where I would place the filler at the bone level to give you more projection and try to fill out that fold, rather than staying superficially to try to soften that fold, then you need a reasonable amount of volume. This is more of a discussion about the concept, then you can decide with your doctor what you’re comfortable with in terms of how much volume you are ready to start with. Then placement of a filler at the cheek level would be a thicker filler like Juvederm Ultra Plus or Juvederm Voluma. At the under eye area in the trough or V deformity area, a filler like Restylane or softer filler like Juvederm Ultra or would be of benefit in that area.
There are a lot of options, and a lot of judgement involved, so  a proper examination will give you a definitive answer. Meet with some doctors to get some opinions. I think you’ll be surprised how many people come up with different ideas. When I show my patients my thinking, I take their photos, I put them up on a screen, and I show them what I’m thinking, and where the volume benefits could be because often we look at things that bother us. We magnify them and we lose the forest for the trees. When I take the photos and show them what they look like at different angles, it really is important and a significant educational experience to see the global issue,s and what can really help you look as young as you are and not look older.
Meet with some doctors to learn about your options. Learn about structural volumizing, begin your journey, and hopefully, you’ll get a place where you’ll look as young as you really are. I hope that was helpful, I wish you the best of luck, and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Hi @dw101101. Thank you for sharing your photos. I recommend a combination of PDO threads and dermal fillers to help soften the nasolabial folds.

Best of luck,

Dr. Nima

From the attached photos it looks as if you need not only injection of filler in the fold but likely some over the orbit just under the eye.  This would give you a fuller cheek under the eye as it looks like in the limited view picture that you have some depression there.  By rounding out the area under the eye it gives you a kind of lift to that area and helps lift the fold too. I would think a 1cc vial per side would give you a good lift and a more youthful look.