Nasolabial folds with pigmentation (photo)

Minimizing the appearance of nasolabial folds, especially when pigmentation is a concern, can be effectively approached through several non-invasive treatments. Since you've mentioned a preference to avoid dermal fillers, here are some alternative options that might be suitable:

Laser Treatments: Laser therapy can help address pigmentation issues by targeting melanin in the skin, leading to a more even skin tone. Fraxel or intense pulsed light (IPL) lasers are commonly used for pigmentation concerns. These treatments can also stimulate collagen production, which might help in reducing the depth of nasolabial folds.

Radiofrequency (RF) Microneedling: This treatment combines microneedling with radiofrequency energy to stimulate collagen and elastin production. It can improve skin texture and tone, potentially reducing both pigmentation and the appearance of nasolabial folds over time.

Topical Treatments: Using topical agents such as retinoids, vitamin C serums, or products containing niacinamide can help lighten pigmentation and improve skin texture. These treatments are often used in conjunction with professional procedures for more comprehensive results.

Chemical Peels: Medium-depth chemical peels can help in reducing pigmentation and improving skin texture. They work by exfoliating the outer layers of the skin, promoting the growth of new, evenly pigmented skin.

Before proceeding with any treatment, it's important to consult with a dermatologist. They can assess your skin type and condition, providing personalized recommendations and ensuring that the chosen treatment aligns with your goals and skin sensitivities.

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture. Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.

Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best,
Dr. Karamanoukian
Realself100 Surgeon

At least from the photos provided, there appears to be some volume deficit in the regions of the upper outer cheeks. Volume deficit in the cheeks above can lead to the development and deepening of the smile folds below, and the deeper the folds the more the shadowing within the folds themselves. To get an idea, just how much this may be playing a role in your problem, simply pull upwards and backwards on your cheeks in the region of the cheek bone projection. You might be pleasantly surprised to find that not only are the smile folds lessened when you do this, but the darkening of the folds lessened there, as well.
I would venture to say that your dissatisfaction with your prior dermal filler treatment was probably because the smile folds were injected directly with filler (rather than filler cheek augmentation performed), which all too often leads to worsening of the appearance, and even to undesirable chipmunk-like cheeks above due to the filler directly in the folds pushing up on the cheek tissue.
You would be wise to ensure that you consult with an experienced, board certified cosmetic dermatologist filler expert. Hope this helps and best of luck. .

I completely understand wanting to minimize the appearance of nasolabial folds, especially if pigmentation is your main concern. Since dermal fillers weren’t the right fit for you, it’s great that you’re exploring other options – and there are definitely treatments that can help!
For pigmentation and texture, laser treatments, RF microneedling, and topical treatments can all be beneficial: • RF Microneedling (like Morpheus8) – This targets both the skin’s surface and deeper layers, improving pigmentation and stimulating collagen for long-term softening of the folds. • Lasers (like CO2 or fractional laser) – Effective at addressing pigmentation and fine lines, which can make the folds less noticeable. • Topical Treatments – Retinoids, vitamin C, and other brightening agents can help with pigmentation over time, though results may be more gradual.
I also have a video showcasing a combination approach using nano fat grafting, Dermapen (microneedling), exosomes, and mesotherapy – all excellent for improving skin quality and rejuvenation. This multi-layered approach can address pigmentation while also boosting collagen.
If you decide to revisit fillers, biostimulant fillers (like Sculptra or Radiesse) might be worth considering. These stimulate collagen rather than just adding volume, which can create a more natural and long-lasting improvement in the folds.
It’s all about finding the right combination for your skin and goals – happy to answer any questions or provide more details!