If Juvederm Didn't Work on my Smile Lines, What Are Some Good Alternatives? (photo)

I had to viles of Juvederm used on my smile lines. It was improved for about a month, but now it has returned to normal especially on one side. I am only 31 and hate that my face looks like it is sagging. Any other products work? My physician only works on faces and has great reviews so I would not think it was the technique. Would another vile help? Or am I just out of luck?

Doctor Answers 17

Smile lines, AKA nasolabial folds, are often exaggerated by flat cheeks

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Some of my patients and I were both sometimes less than satisfied with the results of filler for naso-labial (smile) lines. If you look at a 9 year old, they have folds that are no less deep than yours. What makes them signal "aging" is flattening from loss of volume in the cheeks. I usually put more filler in the mid cheeks than I do in the folds and get much better results.

New York Facial Plastic Surgeon
4.9 out of 5 stars 134 reviews

Smile lines or cheek volume

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Your side profile photo shows that your cheek is deflated. Even if you didn't have big apple cheeks when you were younger you did have more fullness than you seem to have now. By placing filler in your cheek, or Sculptra to stimulate volume, you'd create a better balance in your face. By supporting your skin you'll actually "lift" your fold and better mimic a youthful face. Young persons have folds, "smile lines", but they also have cheek fullness and support. Filling the folds alone doesn't necessarily mimic youthfulness; lifting by filling the cheeks more closely mimics youth.

Juvederm vs. Radiesse vs. Fat Grafting for Nasolabial Folds

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Thank you for the question and your picture. For some patients, the hyaluronic acid fillers (HAs, including Juvederm, Belotero, and Restylane) don't last very long. This can be a quirk in your metabolism -- your body gets rid of the product much faster than average. In these rare cases, I recommend to my patients that we try a different type of filler. For the nasolabial folds, Radiesse is a great option. This is a different type of molecule (cacium hydroxyapatite) and should last longer.  Another option, typically in patients a bit older than you, would be fat grafting. This procedure can provide long-term results in many cases.

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Alternative fillers or a fat transfer

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A few alternatives that may have longer lasting effects include Sculptra, which is a facial injectable that may improve your smile lines at a slower rate, but wil last over a longer period of time.  You may also consider a fat transfer to your face, which may yield longer lasting results and since it is your own body's fat being injected, there is less risk of complications.

Smile lines

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There are many filler techniques that can soften smile lines. Some involve placing filler directly into the valley of the smile line, while others involve filling the cheeks to lift the "sagging" skin directly above the smile lines. I often use Radiesse for this technique because it has a good lifting ability, and I rarely put much filler directly into the smiles lines as a result.

Another thought...any chance you have lost a little weight recently or started to exercise more with the New Year? This can also cause shadowing and folds, especially if you had good results for a month.

Ramona Behshad, MD
Saint Louis Dermatologic Surgeon

Juvederm for Smile Lines

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I think that you will need a long-lasting filler to achieve the results you are looking for.  I would suggest either Radiesse or Sculptra.  There are a few different places that I see from your picture that should be injected to reduce the smile lines you are referring to.  Either of these products would be suitable.  They would be longer-lasting and stimulatory of new collagen to form, adding further correction over time.

Jordan C. Carqueville, MD
Chicago Dermatologist

Alternatives to Juvederm

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Other options you may want to consider for improving the nasolabial folds (smile lines) include a thicker product such as Restylane, or perhaps thinking about fat transfer. Fat grafting can produce natural, long-lasting results when done well.

Jamil Asaria, MD
Toronto Facial Plastic Surgeon
4.8 out of 5 stars 134 reviews

#Fatgrafting for face

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if your smiles lines arent getting better with frequent filler injections I would advise you consider Fat Grafting. thats my favorite filler to work with especially in a patient like yourself that requires frequent filler injections. its very technique dependent. I cannot speak for any doctors/surgeons but if you want to consider that procedure you must do your homework well and find a doctor who speciallizes in it

Filler options

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First, a frontal picture, or seeing in person, would be beneficial to fully assess your concerns.  From your profile picture, you have obvious loss of volume in the cheek region.  This tends to allow the skin to sag and cause folds/lines you are describing.  Treating your smile lines is only putting a bandaid on the problem, while restoring the volume to the cheeks and jaw will support and lift the skin; therefore, lessening the lines.  I tend to use a volumizing filler like Radiesse or Sculptra to treat this area.  The key to fillers is to not only fill in lines/folds, but also keep a natural, balanced and more youthful face.  Hope this helps!

Smile Lines

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Juvederm does work for smile lines as long as it is injected correctly. You do have other options and my favorite injectable material of choice is Radiesse which also lasts longer than most other products. 

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.