I have tried SO MANY treatments for my smile lines, nothing has fully helped. Are there any options? (Photos)

Question

Hi, Ive posted here before about my situation. In 2023 aIposted about how I noticed my smile lines and under eye lines being pretty bad. HI have tried numerous treatments and although ive seen results near my eyes, I havent been able to get rid of the smile lines. I have done two rounds of radiesse (6 months apart) one time diluted all over cheeks, second time directly to upper cheeks not diluted. Ive gotten 3 rounds of PLLA under my eyes and one round by the cheeks. Ive gotten one round of PLLA to the smile lines directly, ive done half a syringe of Juvederm directly to the smile lines. Ive gotten two chemical peels and done two sessions of micrnoeedling. Im 25 and after everything I still see the smile lines. I do want to mention I struggle with smoking and want to know how much that affects my problem. I know its hard to tell from pictures alone but I am exhausted ,out of money ,and dont know what else to do to treat these.

Anna Chacon, MD, FAAD · Answer

Thank you for your message and for sharing your experience along with the detailed treatment history and photos.

First of all, I want to acknowledge how diligent and patient you’ve been in trying a wide variety of treatments for your smile lines. You’ve undergone quite a comprehensive regimen: Radiesse, PLLA (Sculptra), Juvederm, chemical peels, and microneedling. Given your age (25) and the timeline, it’s clear you’re proactive and committed to your skincare.

Let’s break this down:

Why the Smile Lines May Be Persistent:
Genetic structure and facial anatomy play a large role in the depth and appearance of nasolabial folds, especially in younger individuals.

Smoking can significantly impact skin quality, accelerating collagen breakdown, reducing skin elasticity, and affecting circulation. This could be contributing to persistent lines even after treatments that typically help.

Volume placement might be key here. Sometimes, treating adjacent areas like the lateral cheeks or midface with volume support (rather than directly in the nasolabial fold) can help lift the area and reduce the fold more naturally.

Skin elasticity and hydration: If the underlying skin isn’t strong and elastic enough, even volumizing treatments won’t fully correct etched-in lines.

Recommendations Moving Forward:
Consider Hyaluronic Acid Fillers with Higher Flexibility: Products like Restylane Refyne or Belotero Balance are formulated for dynamic areas like smile lines and may provide a more natural improvement than thicker fillers.

Skin Boosters or PRF/PRP: These can help rejuvenate the skin texture and thickness over time. While not volumizing, they improve elasticity and hydration.

Laser Resurfacing (Fractional CO2 or Tetra CoolPeel): These help with skin tightening and collagen production, especially if lines are partially due to skin texture and not just volume loss.

Lifestyle factor: Smoking cessation can dramatically improve your skin’s ability to respond to treatments and regenerate.

Final Thoughts:
You're not out of options, and your frustration is completely valid. What may help next is shifting focus from simply filling to improving tissue quality and collagen remodeling in the area, while addressing the root cause, like smoking. You're young and have beautiful skin overall; sometimes it’s just about finding the right combination and giving the skin the best environment to thrive.

I have tried SO MANY treatments for my smile lines, nothing has fully helped. Are there any options? (Photos)

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