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The nasolabial smile line: To fill or not to fill

Posted:9:23 a.m. Sunday, July 21, 2013

By Anita Mandal, M.D.
Question: I have deep creases from my nostril to the mouth corner. A plastic surgeon suggested filling them, but I’ve noticed the folds look deeper because my cheeks are falling. Would it be better to lift my cheeks?
Answer: The creases you are referring to are known as the nasolabial folds (NLF). In the past, it was acceptable to eliminate deep NLF by filling them. Due to the increased focus on a natural appearance, maintaining a slightly depressed NLF is often more natural looking.

The decision on whether to fill the NLF or lift the cheek area above a depressed NLF depends on the cause of a deep NLF. When NLF tissues, themselves, are losing volume, it makes sense to moderately fill the NLF with an injectable filler.

In other cases, a deepening NLF can be an illusion caused by sagging cheek tissues weighing down over the NLF. In such instances, filling the NLF will only exaggerate facial imbalance and give an unnatural look.

Effective treatment should be directed at lifting the sagging cheek tissues with cheek implants or, more commonly, in my practice, with injectable fillers and/or an Ulthera micro-facelift. Sagging cheek tissues can be due to loss of fat and/or bone, in combination with poor skin elasticity.

It is important for plastic surgeons to take a frontal role in educating patients not only on the various types of techniques and available products, but also on what does and does not look natural.

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