To Smooth out Nasal Labial Lines is It Better to Get Filler in my Check Bones or the Actually Folds?

    At your age you may have some midfacial descent that can be amenable to cheek injections.  The more common scenario at your age is to have subtle nasolabial folds that can be injected directly.  Kenneth Hughes, MD Los Angeles, CA

By understanding the underlying facial fat compartments, you can more fully understand why your face develops folds in the first place.

Each compartment has an effect on the other and it's only by a physical assessment can it be determined which fat compartment(s) might be losing volume.

Structurally it makes sense to consider (and treat as indicated) each interdependent compartment and the overall impact it has and can have on facial contours.

Intimate knowledge of anatomy is a crucial element. Sometimes chasing the fold or wrinkle itself will have no effect - or in some cases - the wrong effect. We all have natural contours that make us look like who we are. Erasing those contours is not the objective. Correctly restoring them to a previous point requires making sure all the various puzzle pieces fit..

You might find it useful to view some of your younger photos and see where you have lost fullness. This will help establish what's going on beneath the surface.

 

It would be helpful if you posted a photo but typically if the nasal labial folds are not too deep and you have nice cheeks I would just fill the nasal labial folds.  If you have lost volume in the mid face evidenced by hollowing under the eyes or flattened cheeks, filling the cheeks will give a nice lift to the face and lift the nasal labial folds making them look less deep.  In some cases I do both areas.  Again, it depends on what each person needs.   

This is a great question. If you're concerned about the nasolabial folds or smile lines as they are sometimes called then injection of the dermal filler in the area of the actual nasolabial folds will give you the best results. However sometimes when volume is restored in one part of the face you may start to notice other areas of the face that are volume deficient such as the cheeks. This is why it's important to have an experienced physician evaluate you prior to any treatment.

The answer depends on the depth of your folds as well as your budget. In some cases, if the folds are mild, then filling the folds or lines is often sufficient. If one is older and the folds deeper, then filling the folds ALONG WITH filling the upper cheeks is a useful way to treat the root cause and the end result for a better more natural look. There isn't a perfect right answer, but the most important decision is to go to a highly trained and experienced physician who will tell you the truth for your situation. ~ Dr. Benjamin Barankin, Toronto Dermatology Centre.

It is really patient dependent, sometimes especially in a young person a little filler directly into the nasolabial folds is enough, in other patients they may need the cheek area augmented as well.  You need to find a doctor you are happy with and work with them.  There is more than one way to address an issue. 

This is a very well informed question. Beginning injectors learn to plump up folds with filler. This works in some cases. As injectors become more advanced they learn to treat the root cause of the problem. Patients with cheek descent or cheek atrophy develop deeper nasolabial folds due to "falling" cheek bones. In people with this problem, augmentation of the cheek treats the cause of the problem (descent of the cheek) rather than just filling the resulting fold. In most cases, I will place a variable amount of filler in the cheek as well as the nasolabial fold to fully correct both cheek descent and a deep nasolabial fold. I hope this information is helpful.

Stephen Weber MD, FACS

Weber Facial Plastic Surgery

Juvederm can work well both as a cheek filler and for nasolabial folds.  Younger people tend to initially develop increasing nasolibial folds before volume loss in the cheek area.  At 35, I would suspect (without a picture) that filling the nasolabial folds would be the procedure of choice.  If there is volume loss in the cheek then filling this area would help.  The bottom line is that you should treat what bothers you the most and go to someone with experience in injecting.

You said you're now confused and without pictures so am I. Both procedures are appropriate but I need to see which is better for you.

Age-related changes throughout the face result from the combination of multiple causes: skin laxity due to the loss of collagen and elastic tissue fibers, loss of subcutaneous fat, gravity-induced sagging in the skin and underlying tissues, and changes in the underlying bony structures. Deeper fillers such as Radiesse and Sculptra are often not injected directly into these wrinkle lines and folds, but rather into multiple areas of the face to treat the volume loss that leads to their appearance. This leads to the subtle and natural-looking results that are so often desired. Patients don’t want to look “done” but also don’t want to look “tired”. Seemingly small changes in shape, proportions, balance, and symmetry can have a surprisingly large effect on our perception of the face.