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Posted: 12:01 a.m. Sunday, July 28, 2019

By Anita Mandal, M.D.
Question: I had Juvederm for my deep nasolabial smile lines several months ago. Ever since my treatment which was performed by my internist at a spa, I look overfilled in my smile lines and my cheeks seem more hollow. I went in expecting to look better but I look worse and unnatural. What went wrong?

Answer: What you have experienced is not an uncommon complaint after filler treatments. There are several reasons why this may have happened.

Nine times out of ten, this could have been avoided had you sought an experienced injector. A specialist such as a Facial Plastic Surgeon who thoroughly understands deep tissue facial anatomy as well as the anatomy of aging already can have a head start on understanding your unique anatomic changes that occur with age.

In your case, it appears that your injector failed to recognize that the deep nasolabial smile lines were due to malar or cheek volume loss. While some patients have primary deepening of the nasolabial fold, others have indirect deepening of the nasolabial fold as a result of mid-facial volume loss. The treatment is different for these two scenarios.

For a patient with deep nasolabial folds who also has significant volume loss of the cheeks, injecting filler into the nasolabial folds alone can give an unnatural appearance. Your cheeks may look even more hollow after treatment. This situation is due to the fact that with age, we not only lose fat in our cheeks but we also lose bone. As a result, the skin has no underlying support and tends to sag, causing the nasolabial fold to appear deeper. The proper corrective approach includes volumization of the cheek hollows along with more conservative filling of the nasolabial folds, using injectable filler.

On the other hand, patients with primary deepening of the nasolabial fold with adequate volume in the cheeks will likely benefit from injectable filler placed directly into the nasolabial fold. Generally speaking, the older one is, the more likely one has volume loss, requiring filler in both the cheeks as well as the nasolabial folds to obtain a natural looking appearance to the face.

There are several safe and effective injectable fillers on the market for treatment of volume loss of both the cheek as well as a deep nasolabial fold. These include one year fillers such as Juvéderm, Restylane Refyne, Radiesse, and also Bellafill, the 5-year filler. While I give my patients several options, the most commonly requested injectable filler in my office is Bellafill because of its 5-year duration compared to temporary fillers.

It is important to recognize that a 5-year filler requires a higher degree of injector skill than temporary fillers which go away much more quickly. If you are interested in Bellafill, you may want to consider seeking a BellaDiamond physician who is in the top 1% of Bellafill injectors in the world.

A thorough consultation with a Board Certified Facial Plastic Surgeon who is also a BellaDiamond expert injector is the first step.

Dr. Anita Mandal is a double Board Certified Facial Plastic Surgeon practicing since 1998. She exclusively specializes in facial rejuvenation and non-invasive body contouring. In addition to being on the medical staff at Jupiter Medical Center, her offices house both surgical and laser suites. Dr. Mandal is committed to giving her patients the most natural looking results.

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