Wrinkles – Nasolabial Folds

Wrinkles Nasolabial Folds

  • Best ResultsImmediate to days
  • Treatment Recovery0 days
  • Procedure Time1-10 minutes
  • Skin SpecialistNurse
  • Duration of ResultsMonths
  • AnaestheticNA
  • Back to WorkImmediately
  • Cost$-$$

Wrinkles - Nasolabial Folds

Probably still the number one requested area to correct. This laugh line has been the topic of debate amongst dermatologists & plastic surgeons for nearly two decades. Treatments are easy; however correction of laugh lines may not give the most pleasing aesthetic results, read more to understand why.

FactsFacts on Nasolabial Fold Wrinkles

  • Dermal fillers can lessen nasolabial fold lines
  • Other options include skin tightening devices
  • HIFU or high intensity focused ultrasound can provide lifting
  • Radiofrequency is another option to lift laugh lines
  • PDO threads can give good results in some cases

What are Nasolabial Folds?

The nasolabial folds are referred to as smile lines or laugh lines. This fold separates the cheeks from the mouth. They run from the nose to the corners of the lips.

As we age, our face changes in many ways which eventually leads to these folds descending, becoming more prominent & deeper. The most important thing to grasp is that these folds are normal. The aim of treatment is to lessen the look of the NL fold.

Perfect example of leaving NL folds alone.

What is the best treatment for nasolabial folds?

It really depends on the depth of your folds as well as your facial shape, skin quality, laxity, & ethnicity. In most cases, dermal fillers in, or near the fold can help reduce the depth of NL folds. Other treatments include-

  • Skin tightening with HIFU, RF, Tempsure, Pelleve, Thermage
  • RF microneedling with Infini, Genius, Morpheus 8, Intensif, Secret
  • Fat transfer including nano-fat & ASC
  • Laser resurfacing with CO2; if skin quality is an issue
  • Surgical face lifting if associated with mid face laxity

    I tend not to treat the fold itself (as in this pic.), I prefer to support & blunt the folds medially.

Which filler is best?

For nasolabial folds I usually employ a thicker filler at the base. It gives support & lifts the medial cheek without adding volume. I also use a thinner filler in the NL fold itself, delivered via a cannula.

I work with brands across 5 ranges, & I select the best product from each company portfolio.

Which filler lasts the longest?

Non- HA fillers, in theory, last longer than HA fillers. The former includes PLLA (Poly L lactic acid or Sculptra). Calcium hydroxyapatite fillers can also last longer than HA. Collagen stimulating fillers

Pros: Last longer, stimulate collagen, in the long run cheaper than HA fillers

Cons: Not reversible, if you get this in an artery you are in big trouble.

Davin’s Viewpoint on Nasolabial Folds

Nasolabial folds are not necessarily unattractive. They are natural however deep grooves can pull at the corners of the mouth and give a person an unattractive scowl (more DAOs in this context). Deep furrows can make a person look many years older than they are.

Fillers can be used in many ways- support of folds, blunting & of course filling. My technique is to reduce the depth, & not eliminate folds all together.

I have a hard time convincing patients NOT to get specific lines ‘filled in’ as this will give an unnatural look. Yes, I was guilty of filling in the NL folds in the early 2000s when we did not know any better. Fast forward to 2022 & beyond, & we all know the importance of facial harmony & balance. In many cases my NL fold treatment is to blunt the angle & lessen the piriform shadow. This indirectly reduces NLF depth & importantly supports the medial cheek. I believe this injection point will suit most people, especially if there is associated lower face laxity. My viewpoint is that adding too much filler ‘drags’ the lower face inferiorly, especially if fillers take in water (or accumulate with time). Compound with the fact that most patients also have associated areas such as the marionettes & pre-jowl sulcus treated at the same time. This further adds to the volume of the lower face.

Do not just look at NL folds, it has to be treated in context with the surrounding skin & overall landscape.

Fat transfer is an interesting proposition. In the context of safety, my practice is to inject with a huge 18 G cannula. The limiting aspect of fat is the unpredictability with absorption.

For those who are against injectables (then you’re reading the wrong website), there are always PDO threads. Results are much less predictable than fillers. Ideally PDOs are combined with energy devices. I do not like using suspension threads just to lift the NL folds as results are relatively short lived (average 6 months). This group of threads just don’t do it for me, especially when you look at the risk benefit ratio & duration of action.

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