Question: I am 61 and have been using fillers for my deep smile lines and marionette lines. Restylane and Juvederm seem to make them less deep but the smile lines are still visible on the skin surface. Is there any filler that can I do to get rid of those stubborn lines?

Answer: The nasolabial area is the region between the corner of the mouth and the outer edge of the nostril. Some patients are born with lines or grooves in this area due to genetic predisposition. Many, however, acquire these lines and/or depressions as a result of the aging process.

A distinct difference exists between nasolabial depressions or grooves and nasolabial lines. The former is the result of volume loss in the deeper skin layers or bone layer but can also be due to fat loss in the nasolabial zone. However, the nasolabial lines develop in a more superficial plane of the skin.

Understanding the anatomy of the nasolabial area is key to identifying the correct approach to treatment. Volume loss in this region presents as a groove or depression. Treatment consists of injectable fillers such as Bellafill – the 5-year filler, Restylane Refyne, Juvederm Ultra Plus, Radiesse, or RHA 3 which are all designed to be placed in the deeper tissues to restore volume.

When it comes to superficial lines in the nasolabial zone, injectable fillers – designed to be placed in the superficial skin – such as Restylane, Restylane Silk, RHA 2, or Juvederm Ultra XC – can give effective softening. It is important not to place deep-layer fillers into superficial nasolabial lines to avoid an unnatural, bumpy appearance in this area.

Some patients have both depressions and superficial lines in the nasolabial zone. Filling the depressions alone can leave one with residual nasolabial lines. A 2-layer injection approach can adequately correct aging in the nasolabial area with stacking of filler in both the deep and superficial planes. This dual-layer technique with the pairing of 2 different injectable fillers can be performed within the same session.

Other patients have concerns about deep nasolabial grooves but, in fact, have volume loss of the cheek area above the nasolabial zone. The cheek volume loss results in loss of support of overlying skin and muscle causing the cheek tissues to descend towards gravity. This cheek sagging can give the appearance of a deepening nasolabial zone but, in actuality, is the result of cheek aging superior to the nasolabial area. It is important to seek a skilled injector who understands the intricate anatomy of facial aging since the correction of this concern is volume restoration of the cheeks instead of an injection of the nasolabial area.

A detailed consultation with a Board Certified Facial Plastic Surgeon who is also a Master Injector is the first step in determining your facial rejuvenation needs.