I have a shadow hollow nasolabial fold. I want a long lasting treatment. What would you suggest? (Photos)

Thanks for your question. I would really be careful how aggressive you are with your nasolabial fold treatments. Even babies have nasolabial folds and the amount you have appears natural and appropriate. Permanent treatments have the benefit of being long-lasting, but also are not easily reversible, and the quality of the result can decline with time regardless. Deep plane facelift treatments are essentially the best permanent method of addressing the true cause of excessive nasolabial fold show, but it really doesn't appear to be something you would benefit from at this time.

I recommend fillers to soften the nasolabial folds themselves and also lift around the mouth and cheeks to build underlying anatomical support. In our practice we combine Sculptra with other fillers "layered" on top and lasers, skin tightening treatments such as Thermage, Fractora, and Renuvion (J Plasma), thread lifting, and peels to get the most conservative, natural look. I suggest seeing a facial sculpting expert for a formal consultation. Best, Dr. Emer

I would definitely start by trying a HA filler to start and make sure this is a look you actually would like long term before considering the other treatments.  Fat transfer is a great and natural approach as well as sculptra.  I would advise setting up a consultation with a board certified plastic surgeon to discuss in person and determine what plan best fits your needs.  kh

First, let me say that even the best of photos are no substitute for an in-person examination that not only allows for closer examination, but for palpation and manipulation of the tissues. I would also like to add that, at least from the photos, the nasolabial (smile) lines do not actually appear that deep, so it is important to emphasize that experienced injectors no longer strive to completely eliminate the smile lines as this can lead to a very unnatural and undesirable look known as the "simian facies," or the smile line-less face of a monkey. The use of permanent fillers has been associated with the potential occurrence (even five, ten or twenty years later) of disfiguring nodules and granulomas that are very difficult to treat. What's more, permanent fillers, like permanent implants, do not change with time, which means as the surrounding tissues do change with aging, what may have looked nice when you are first treated may look unnatural years later. Sculptra requires several treatment sessions, does not yield immediate results and typically is expensive. Fat injections often do not last as long as promised and what's more fat retains the characteristics of the region from which it is taken (buttocks, hips, thighs), which means that when those areas "put on weight" with aging, so can the fat injected into the face. Should treatment of the smile lines actually be needed, one way that I have found for prolonging the effects of fillers is to accompany the filler injections with subcision, a simple technique that stimulates new, native collagen and elastic fiber synthesis. Make sure that you consult with a board certified aesthetic physician with experience and expertise and ask to see his/her personal before and after photos. Best of luck.

A hyaluronic acid based filler like Restylane Defyne will help soften the nasolabial fold. I hope this helps.