32, extremely deep nasolabial folds - Treatments for structural nosolabial folds?

Question

I am 32 yo and my nosolabial folds are extremely deep. They always been like that, however, because of my genetically given cheeks. Despite the photos of face alone I have never been overweight (size XS now!). I did lipofilling to midface 6 months ago, but it didnt improve the folds - obviously , since they were always there even in youth. My Surgeon Now suggested dermal filler to the folds themselves, another surgeon said that would be a terrible idea, and that need to do Sculptra in cheeks and subcision for the folds. My case is a little too specific, so I’d like more opinions. Photos are from now and from 11 years ago.

Nelson Lee Novick, MD · Answer

In general, performing a nonsurgical cheek augmentation with a robust HA voluming filler addresses not only volume deficit in the cheeks, but provides sufficient lift so as to improve the smile folds. However, at least from the photos provided, volume deficit I the cheeks seems not to be the primary issues. If this is indeed so, then the use of an appropriately robust HA lifting filler injected directly into the smile folds themselves should provide a sufficiently gratifying lift and smoothing without providing unnecessary bult to the cheeks.. You would be wise to consult with an experienced, board certified cosmetic dermatologist filler injection expert and best of luck.

Anna Chacon, MD, FAAD · Answer

Thank you for sharing both your current and older photos. One detail that stands out is that your nasolabial folds have been present for many years, even when you were younger. That strongly suggests this is primarily an anatomic feature rather than a sign of premature aging.

Because of that, I don't think there is a single treatment that will completely eliminate the folds, and it's important to set realistic expectations. The goal is usually to soften them while preserving a natural appearance.

The fact that midface fat grafting six months ago did not significantly improve the folds is also informative. It suggests that the folds are not simply due to volume loss in the cheeks. This makes me cautious about continuing to add more volume to the midface unless there is clear evidence of deficiency.

As for the differing opinions you've received:

Injecting filler directly into the nasolabial folds can work well in selected patients, particularly when the fold is caused by volume loss. However, in someone with naturally prominent folds, overfilling the area can create a heavy or unnatural appearance and may not address the underlying anatomy.
Sculptra stimulates collagen production gradually and is best suited for restoring diffuse facial volume rather than correcting a fixed structural fold by itself. If your cheeks already have adequate projection, additional volume may provide only modest improvement.
Subcision is an excellent option when the fold is tethered by fibrous bands beneath the skin. It releases these attachments, allowing the skin to lift more naturally. However, not every nasolabial fold is tethered, so its effectiveness depends on your specific anatomy.

For patients with lifelong, structurally deep nasolabial folds, the best results often come from a combination approach rather than relying on a single treatment. This may include subtle support of the midface, conservative filler where appropriate, and subcision if there is significant tethering. The treatment plan should be tailored to your facial structure rather than following a standard protocol.

One encouraging point is that you are only 32 and have maintained a stable, healthy weight. Since your folds appear to be primarily genetic rather than age-related, preserving facial harmony is more important than trying to erase every crease. Overcorrection can make the face look less natural than leaving a small amount of the fold.

Based on what you've shared, I would be cautious about placing a large amount of filler directly into the folds without first determining whether tethering or facial structure is the primary contributor. A conservative, anatomy-based approach generally produces the most balanced and long-lasting outcome.

32, extremely deep nasolabial folds - Treatments for structural nosolabial folds?

Answers (2)

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