Will subcision with fillers help my nasolabial folds?

Our office has many different treatments for acne scars depending on the depth of atrophy or hypertrophy. Acne scars require a combination approach using our HIDEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of acne scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic acne scars and indented acne scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be been improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional laser such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture. Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone.

Subcision works well alone and in combination with other laser and RF platforms, including fillers and air subcision. TCA Cross can be combined with subcision. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your acne scarring.

Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best,
Dr. Karamanoukian

I recommend fillers to soften the nasolabial folds themselves and also lift around the mouth and cheeks to build underlying anatomical support. In our practice we combine Sculptra with other fillers "layered" on top and lasers, skin tightening treatments such as Thermage, Fractora, and Renuvion (J Plasma), thread lifting, and peels to get the most conservative, natural look. I suggest seeing a facial sculpting expert for a formal consultation. Best, Dr. Emer

Unfortunately, without at least photos (and better still an in-person examination that allows for palpation and manipulation of the involved tissues), it is really difficult to comment in any but the most general terms. What I can say is that very frequently patients come to me for the first time with precisely the kind of complaint you have--i.e. direct treatment of the smile lines with fillers that don't work and in fact, make the surrounding cheek higher and the depression deeper.  Inexperienced, novice injectors frequently inject directly into the folds, a process disparagingly referred to as "chasing after wrinkles,"  something that experienced injectors have not been doing for the past fifteen or more years. Instead, proper contouring and lifting of the cheeks surrounding the folds not only improves and rejuvenates that region directly, but typically leads to secondary improvement improvement in the smile folds (often without any need for directly injecting them). And while subcision is certainly an excellent method for elevating and smoothing depressions (particularly) depressed scars (and one that I use all the time for the appropriate purposes), it is much less often used (or needed) for treating smile lines. You would be wise to seek consultation with a board certified aesthetic physician and make certain to ask to see his/her personal before and after photos before agreeing to proceed. Best of luck.