Juvederm in cheeks or nasolabial folds? (Photos)

Thank you for your question. You submitted several photos,and ask about the possibility of getting Voluma in your cheeks, or Juvederm Ultra Plus into your nasolabial folds, as well possible enhancement in the chin area.  I can share with you my approach to patients who ask similar questions in my practice.
A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Helping people with facial aging is a very significant part of my practice, but not just facial aging, but often the genetics of facial volume.
You’ve certainly done your research and learned about the specific indications for these different fillers. For a little guidance about the approach, this is what differentiates different doctors in how they do things, and everyone does things in their own way. I understand the confusion about what the best solutions are for these different anatomic areas.
I’ll tell you a bit about what I do when I see patients at consultation. I begin by taking photos from the front view, three quarters, side views for both sides, then I place these photos up on the screen. I help people understand where there are things that look like opportunities to improve in a more global sense, and I listen very intently to the priorities of the patient.
You are familiar with Juvederm Voluma, so we’ll start with that. Voluma has a very important role in different ways in the spectrum of options available. I would caution you with any filler for volume in the cheek area and nasolabial fold because you need to place the filler at the right level. It is very common for patients to  discuss these concerns with me, then when I talk to them about different fillers, literally without any exceptions, patients will always say “I don’t want to look like a chipmunk. I don’t want to look like I’m all puffed out.” because they see too many people who do look like chipmunks, and they see too many well-known people who look very swollen and pillowy.
Some patients who have gotten these fillers elsewhere were undercorrected so they felt like they got nothing, or they got too much so they were unhappy with the results. The basic issue is in the technique and placement. There is an anatomic concept that takes a bit of time to understand but I’ll explain it they way I do with my patients.
When you look at your cheekbone area, there are compartments that have to do with volume loss, genetic volume deficiency, and potential space. What we’re not doing is necessarily an augmentation, but rather a correction to help restore facial harmony and balance, so you avoid that puffy look. Now how do we get a nice, youthful angularity? This is something I really take issue with because a lot of my colleagues believe a youthful appearance means smooth skin only, so they often overfill the face, so they end up looking more rounded.
There’s a concept called structural volumizing where the placement of these fillers, particularly in our practice, where we use long-lasting fillers such as Juvederm Ultra Plus and Juvederm Voluma placed at the bone structure level. The fillers are placed below soft tissue to prevent people getting more rounded, because at the level of the bone can be much more defined. By placing at that level, the cheekbones look more angular and natural. The skin actually glides over the cheekbone, and doesn’t have the physical weight when the cheek becomes filled. Often, when people have a volume deficiency, a very well-meaning doctor will place this material in the soft tissue space which creates volume that may look good on the chair, but afterwards, as the person talks and smiles, the material gets softer and spreads out a bit, then they look kind of strange and pillowy.
I think there’s an opportunity in your situation to restore volume in the cheekbone. Yes, you can soften the nasolabial fold, but I’ll tell you that, in my experience, often once I restore cheek volume, the nasolabial fold gets less significant because you achieve a balance. If you look at younger people, a lot of them have significant nasolabial folds, but they also have balance and volume. There’s something called the golden ratio where the upper part of the face is slightly wider than the lower part of the face. It’s a 1.6:1 ratio, so when you create that, there’s this natural perception of facial harmony.
Speaking about facial harmony, to address the issue of the chin, it is very interesting how a little projection of the chin we’ve done traditionally with chin implants, we can now do with thicker fillers such as Juvederm Ultra Plus and Juvederm Voluma. You can get also some balance both from the front view of the length of the face to proportionally balance the upper third, middle third, and lower third as well as in the profile view, which together can look very good. It goes back to structural volumizing, putting the material at the level where it makes the most impact. One of the things about maturing is significant bone loss, and that bit of bone loss can result in a lot of volume loss, so placing it at the right place really makes a difference.
I have to always emphasize that fillers with the names you know are really just tools for a skilled practitioner to apply for an optimal outcome, so communication between you and the practitioner, and the methods employed are what ultimately creates the best result. Meet with some doctors and get some opinions, learn about structural volumizing, and I think you’ll find that even if you take small steps, you’ll find this will be a very good strategy for you.  I think you shouldn’t necessarily focused on the specific products, but rather the technique and the end result. 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.

The product of choice depends on what area you want to treat.  JuvedermUltra Plus works great in the nasolabial folds.  Juvederm Voluma worksbest in the cheeks.  Talk to your injector to discuss what your goals are,he or she will choose the right filler for your needs.

Fillers can be used to contour the face, I suggest you see a physician who does contouring and not just line filling.  Best, Dr. Emer.