1 Syringe of Restylane in Nasolabial Folds - Why Are Lines Still There?

You may not be undercorrected or you may be. Only an examination can tell. Photographs are not enough to discern your condition satisfactorily. If the lines are deep and broad, then more filler may help, but if they are thin creases, you may risk seeing lumpy filler if more is done. You may be right about needing volume in the cheeks as this is what we've learned in the last decade. Volume depletion of fat makes your cheek lose the support it once had and then smile folds deepen as the cheek descends. Jowls also start to form. Perlane, the deeper component of Restylane, Juvederm Ultra Plus and Radiesse, Fat  Injections and Sculptra may help build the deeper tissues of the cheek. These are off labe uses for some of the fillers so see an experienced physician who performs panfacial augmentation (this can be called many different things).

Hi,

Without seeing your face, it is difficult to answer your question.  Perlane, Radiesse, and Juvederm Ultra Plus are thicker fillers that are good for restoring volume to the face and giving a bit of a lift.  For global overall volume filling of the face I prefer Sculptra.  The skill and the experience of your injecting physician does play a role in your ultimate outcome.  Choose your injecting physician most carefully.  Good luck and be well.

Dr. P

I always tell patients, the line or wrinkle will not be totally gone, just softened. Results from injectables should be somewhat subtle and not at all close to results from surgery. Without seeing you it is hard to say if more filler is indicated. If the folds were deep, more product is necessary, but you also don't want it overdone so it looks strange and unnatural. Building volume, such as the cheek certainly can require a lot more product. If you went to a board certified plastic surgeon, I am sure it was done correctly. Perlane may be slightly more bulky, but I would anticipate a similar overall result with all of the hyaluronic acid fillers. Before and after photos are a good way to assess overall results and I would go by the recommendations of your doctor whether or not additional syringes will give you a result you are happy with.

Restylane is a great filler.  Every face is different and the needs are different as well.  If the filler is injected deeper, for whatever reason, the effects will often be lessened.  In addition, 2 syringes is the average amount of filler used in cosmetic cases, with many patients getting the best result with 3 or even 4 syringes.  Remember, once the result is close to what you are looking for, the result will last for close to a year and the repeat injection last even longer. 

The restylane in the folds will not efface all lines but will soften the folds.  You do not want to remove the folds completely, because that does not look natural.  As for the cheeks, perlane is an excellent choice.

Would recommend Sculptra in the cheeks to restore volume and this may further correct the nasolabial folds.

Regarding:  "1 Syringe of Restylane in Nasolabial Folds - Why Are Lines Still There?
I had restylane injected into my nasolabials three days ago, one syringe on each side was done, tho she did use s little under my bottom lip and a little bit above my cheek area out of each syringe per side, but I can still see my lines, do I need two syringes done for each side or do you think she didnt inject correctly? I need to build more volume in my cheek area as my face looks kind of flat is that why the lines are still showing? would Perlane be better for that?"

To paraphrase your question, you had 1 syringe (?1cc) of Restylane to each Nasolabial fold and yet "the lines are STILL there". What could be the explanation? Without a BEFORE picture to understand just how deep the lines were and what was the extent of facial deflation of sagging we cannot give you a precise answer. Instead one or more of the following explanation could be applicable. They are being answered in random fashion NOT in order of likelihood.

1. The depth of the Nasolabial folds was such that more volume was required OR that a combination filler -THICK (Perlane or Radiesse deep) and Restylane more superficially, May have been a better option

2. You had the kind of Nasolabial folds which would be far better addressed with a Facelift procedure than with filler

3. Your injector was inexperienced and used a questionable technique

4. You should have received ANOTHER filler (? Radiesse or Perlane) instead of Restylane

5. You did not receive Restylane. Some Salons and unscrupulous doctors purchase what they THINK is Restylane from abroad. This is in direct breach of Federal law. A fair amount of such fillers may be counterfeit (usually China) and not deliver what it is supposed to deliver.

I hope your injector was an experienced Plastic surgeon / Dermatologist with whom you can discuss your issue and formulate a plan.

Dr. Peter Aldea

If Restylane is injected into etched lines, you can see the Tyndall effect from the HA being too superficial. I use fillers to reshape rather than just fill. It sounds like you need filler into the cheeks as well. Radiesse may give you more lift, but Juvederm Ultra Plus, Perlane and even more Restylane might be the answer. Take to your doctor  and get more volume enhancement than line filling.

Restylane is a good filler and it has been out for quite a while.  In my practice, I reserve it primarily for lip augmentation and I use the thicker fillers for the Nasolabial fold area, usually Radiesse, Juvederm Ultra, or Perlane.