Hi, you don't really have true nasolabial folds which is called smile lines. You have less fat in paranasal fold area (next to the nose.) Other than filling with dermal fillers, there is a silicone paranasal fold implant which can help, but I have some issues with that procedure. Many patients who have the silicone implants in this area, do like the results when they are not smiling, but when they smile, the silicone is too firm and does not compress like fat. For this reason, I prefer using a denser dermal filler like Restylane Defyne or Refyne which also resists deformation, so it's tendency is to spring back to its original shape after it is "smushed" like when you actively smile. When injected into the correct anatomic location, it acts as a firm, but softer implant which feels like your own tissues. When done properly, if you stick your tongue under the area of the smile line you should not see a "speed bump" which is usually intradermal/subcutaneous filler. EXPLANATION: If you look at children and teenagers without these shadows, you will notice their cheek fat pad blends right down to the upper lip without a shadow. During my consultation, I have a video examining one of my children to show the presence of fat in this area. As a contrast, I also have these same paranasal folds at the age of 50. I contrast my anatomy to my child's anatomy to show the loss of fat in this region. To properly revolumize this area, is more about filling the right layer. If filler is injected in the manufacturer's specified "intradermal" injection, this will help the fold initially, but over time, the filler migrates upwards, making the nasolabial fat pad thicker. Then the process is repeated and the nasolabial fat pad gets even thicker. Often times, including for a patient yesterday, I will dissolve the old filler to reduce that area. Afterwards, the true area of fat loss is revolumized. This type of filling lasts longer than the intradermal filling, which the results may last about a year. I think that the filler material lasts much longer than a year, but the shadow/fold improvement doesn't last the full year, which means that the filler is moving with each smiling movement. When the person is not smiling as in your photos, the paranasal fold area has less shadowing. By not filling subcutaneously, when the person smiles, they can create a natural looking smile line. When they stop smiling the filler pushes the fold out, as seen in young people. The weird thing is when patients as to eliminate smile lines when they are smiling. This would require the subcutaneous/intradermal filling. However, if we examine how children and teenagers are shadowless around the paranasal fold area when not smiling, and able to form a proper smile line crease when smiling shows us what nature intended. I prefer to follow nature for a natural appearing result. I have a paranasal fold powerpoint presentation for consultations with video to explain. For my link, I will include my upper eyelid filler gallery to show what I think looks like natural looking results. If patients want #Russianlips or other unnatural procedures, I direct them to other providers who are more than happen to offer them the "trending procedures." Good work should not be visible to the casual observer. Hope this reply provided you with some value. Good luck. Best, Dr. Yang
