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Posted: 6:00 a.m. Sunday, April 8, 2018

By Anita Mandal, M.D.
Question: I have deep smile lines that run from each nostril to my mouth corners. I’ve had them since childhood but now in my 60’s, they are much deeper and really age me. A plastic surgeon injected filler into them and while they looked better for a while, the filler made my smile lines look fuller than my cheeks. I looked a bit strange. With the filler gone now after a year has passed, I look more natural but my deep smile lines are back. Is there a way to soften smile lines without looking unnatural?

Answer: The lines and depressions that extend from your nostril edge to the curves of your mouth are commonly referred to as nasolabial folds (NLF). Many people develop deeper grooves or lines in this area as their face ages. Although a deep NLF is a common facial rejuvenation concern, diagnosing the true cause of these grooves is key to effective treatment and a natural result.

There are two categories of NLF aging. Some patients mainly have deepening and loss of volume restricted to the NLF area itself. In these cases, treatment is often straightforward, with direct filling of the NLF. In those who also have superficial lines, combining a deep filler like Radiesse or Bellafill – the 5 year filler – for the depressions with a superficial filler such as Restylane Silk or Bellatero for the surface lines can give optimal results.

The second type of NLF aging, and one more common, as the face ages into the 60’s, 70’s as well 80’s occurs when a deep NLF is not only due to mild to moderate deepening of the fold itself, but also the result of volume loss in the upper outer cheek. Cheek volume loss is typically the result of a ptotic or “droopy” malar fat pad which, in a youthful face, sits high on the outer upper cheek. However, with age, this fat pad descends downward and towards the center of the face, resulting in a volume deficiency over the cheek bone area. As this fat pad descends, it creates the illusion of a deepening NLF. Recognizing when a descending malar fat pad is causing a deep NLF is key to effective treatment with natural results.

A patient with deep NLF’s in the presence of ptotic malar fat pads should typically undergo volumization of the cheek as well as conservative filling of the NLF’s for a natural result. On the other hand, a patient with moderate to deep NLF’s, who has a normally positioned fat pad with minimal to no volume loss of the upper outer cheek, can often have a successful, natural result with direct treatment of the NLF using injectable filler.

A Board Certified Facial Plastic Surgeon who is also a skilled, expert injector can properly assess your aging anatomy and determine the optimal treatment approach for your individual needs to give you the most natural results.

 

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