Nasolabial folds. Loose skin or fat loss? (Photo)

Question

I've seen two doctors. One said I have fat loss and recommended fillers in my cheeks and temples while the other said I have a bit of skin laxity and recommended skin tightening treatments. I don't know which one is more suitable. Do I look like I have fat loss or lax skin?

Brandon Richland, MD · Answer

Hello, and thank you for your question. In the posted pictures, nasolabial folds are not very prominent. If you are referring to lower face heaviness, which can happen as we age, you could go either route with filler or potentially skin tightening procedures. Filler can be placed in the lateral cheek and in the lower face (jaw and chin) to help provide more structure and definition. Filler in the cheek can help soften nasolabial folds, while filler in the lower face can help with jowls and marionette lines. Skin tightening procedures can range but a possible one to try is Morpheus8. It can help rebuild collagen and tighten the skin over time, but this does require several treatment sessions. However, these are more lasting results compared to filler. I would recommend consulting with a provider who specializes in filler and skin tightening procedures to better determine your treatment options.

Raffy Karamanoukian, MD, FACS · Answer

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Jason Emer, MD · Answer

It's difficult to say without the benefit of a formal evaluation. This is my expertise and a huge portion of my practice. Asymmetry is normal and expected. See an expert who does facial shaping with surgical and non surgical methods to get a comprehensive option. Best, Dr. Emer.

Amelia Damse, DO · Answer

It looks like you have some volume loss in the central face (cheeks) which is causing your skin to appear more lax around the nose and mouth, and even in the undereye area. Adding some filler in the cheek will correct this and lead to some lift as well, decreasing the appearance of shadowing in this area.

Nelson Lee Novick, MD · Answer

Age-related volume loss, particularly in the deeper fat pads of the skin, as well in the muscle and bone below, is largely responsible for the sagging, jowls and supposed overall "laxity" of the surrounding envelope of the skin. Unless, the underlying volume deficit is addressed, any attempt to tighten the skin envelope is unlike to result in a rejuvenated look. More commonly, by simply stretching the skin over the underlying residual tissue, as is often the case in surgical facelifts that cut off the supposedly excess overlying skin, the result is a skeletonized-looking face that so often engenders the much feared comment by observers, "Oh, she's been done."  If volume loss is the underlying issue, as seems to be the case here, volume repletion with the use robust volumizing and lifting fillers is naturally the appropriate way to go. Filler augmenting of the cheeks will create a more ideal, feminine heart-shaped face, which will, at the same time, lessen the smile folds, create a more gradual transition between the upper cheek and tear troughs, and even to some extent improve the incipient marionette lines. To repeat, volume loss requires volume repletion, not cutting away supposedly "excess" skin. As to the skin tightening devices out there currently, unfortunately (even if the need for skin tightening were really the issue), the hard science to support the purported benefits of the current "bells and whistles" devices lags well behind the intense marketing and advertising to promote their use. Make sure to consult with a board certified cosmetic dermatologist and best of luck.

Michael I. Echavez, MD · Answer

Based on your photos, it appears to me that lack of volume is the main issue, so I would recommend dermal fillers.

Camille Cash, MD · Answer

From your photos it appears you have some volume loss.  Fillers can help replace this and improve facial contours.  HA fillers typically last 1 to 2 years.  If you are wanting more longevity you can also consider Sculptra which works differently than HA fillers.  I've included a video I hope you find helpful.

Randy Dean, MD - Account Suspended · Answer

Hi and welcome to our forum!
The process of aging involves BOTH fat resorption and skin relaxation due to gradual rupture of dermal elastic fibers.

Treatment depends upon personal preference.

If you are dissatisfied with the projection of your upper lateral cheek (malar eminence), injection of fillers to the cheek and temporal areas will temporarily fill (6 months or so) and subtly lift the cheek. If you find this satisfactory, you may repeat the injections at intervals or ultimately consider a permanent implant.
If you are satisfied with the current shape of your face, consider a skin tightening procedure such as facelift.