I have a deep nasolabial fold on the right side of the face. What's the best permanent treatment, apart from fillers? (Photo)

Question

I went to see a plastic surgeon who did hyaluronic acid injection which hasn't made any difference but worsened the look as now my cheek looks like I have some lump. What is the best clinic and treatment? I considered a mid face lift but not sure it's appropriate for my age. I would like a treatment what would give the best result and would be permanent as I can afford to spend too much money. Thanks!

Andrew P. Trussler, MD · Answer

The nasolabial fold is a natural crease separating the cheek from the perioral region. Treatment of the nasolabial fold depends on the depth of the crease and the cause. From the photos, what you are complaining of is the perialar region which is the upper most area of the nasolabial fold under and beside the nose. If not filled with treatment of the nasolabial fold, this can actually accentuate the area. I would recommend filling this area to see if that meets your goal.Other options for the nasolabial fold include a cheek lift or midface lift which can help to efface or flatten a deep nasolabial fold, though this is usually not the primary focus of this procedure. Other options which are effective, are direct excisions of the nasolabial fold which actually removes the entire fold, and leaves a fine scar line where the natural crease is. This is the most effective procedure for the deep nasolabial fold, and is commonly applied to that area even after a cheek or full facelift.

Michael A. Zadeh, MD, FACS · Answer

Most people have noticeable asymmetry to their faces, so it is not unusual that your right nasolabial fold is deeper than the left. I would still recommend continuing with filler treatments as it will give you the best, non-invasive result when done properly. You probably did not receive enough product during your first treatment and need more. Another thing to consider is adding some filler to add volume to your cheeks. This will also help decrease the depth of your nasolabial folds. Hope this helps answer your question.

William B. Rosenblatt, MD · Answer

There is no permanent answer. All fillers are temporary -- fat might last longer - but even the best results with Radiesse - which I prefer as I think it lasts longer - is not permanent. Also a facelift is not for you. You just might have to live with a little asymmetry and get fillers once or twice a year to help fill up your NL fold.

Darryl J. Blinski, MD · Answer

Doing any surgery will be much more expensive than twice a year filler injections. The injections need to be done correctly...

Edwin Ishoo, MD · Answer

The pictures you have posted are after HA injection and are not adequate for proper assessment. It is better to post good clinical pre-injection pictures which I'm certain your doctor took of you. Next, before we talk about how to fix it, we need to find out whats causing it. Is it a congenital soft tissue/ skeletal atrophy or hypertrophy? Do you have a malar depression that causes more sagging on one side than the other (implant)? is there asymmetric muscle contraction causing the fold that could improve with neuromodulator such as Botox? Can't treat without correct diagnosis. Its true even in cosmetic MEDICAL practice.Lastly, I find that if I'm trying to correct deep NL fold especially in a young person, Subcising the fold before placing filler gives me a much more natural and long-lasting result. It starts with good clinical pictures and good repose and dynamic musculoskeletal exam. You are not a typical "filler" patient.

Kathy Rumer, DO · Answer

You look to be very young in your pictures, so I would say that a facelift is probably not the procedure for you.  If you are not happy with the hyaluronic acid injection that you received you can go back to the person who injected it and ask them to inject an enzyme call hyaluronidase to take it away.  I don't know that I would recommend anything permanent in this area.  Without a full face picture it is difficult to assess, but you may want to consider seeing someone to have some facial fat grafting done.  Which will last a lot longer than most facial fillers and if done correctly should completely correct what's bothering you.  Best of Luck!

Francis R. Palmer, III, MD (retired) · Answer

Based on these photos, I believe you have a very flat cheek area.  Adding augmentation to the cheeks will shape your face.  You can have fillers (or implants...to be decided at your consultation).  You may still need a bit of filler to the nasolabial fold line, but adding volume to the cheek to shape the face will help.

David E. Berman, MD (retired) · Answer

fat should be fairly permanent after the initial loss of some volume. however, this does not meanthat you should expect it to be perfect. Radiesse is an excellent filler that usually last 1.5 - 2.0 years oreven longer. a Fat transfer will be more expensive. this is a better alternative to a face liftor mid face lift for you.david berman md

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