All too often, having Botox or Dysport is an awesome experience until the remarkably unlined upper face paints a stark contrast against the untouched lower face with its tell-tale nasolabial folds. Rejuvenation would be incomplete if the loss of volume and lines from the midface down to the chin weren't addressed. Surprisingly, sun damage, unhealthy habits and weight swings create more havoc than chronological aging. Not to worry, Aesthetics is now a whole new ballgame with non-surgical dermal fillers producing remarkably natural-looking results on both the young and the young-at -heart with no downtime, considerably less pain and a fraction of the cost of surgery. At Juvly, it"s not just a matter of filling but also a matter of simultaneously lifting so the contour looks natural.
The passage of time causes changes at the cellular and anatomical level which is seen as loss of fat or volume and the development of lines. Graviity, loss of bone mass and redistribution of fat makes the older face saggy, jowly and lined. With a approxiate loss of 1% of collagen per year after the age of 20, time can catch up with us very fast.
There are many kinds of FDA approved dermal fillers that are more specialized than earlier versions allowing doctors and injectors to recapture the smoothness, contours and harmony of a youthful face with greater ease. Some of the absorbable non-surgical fillers are hyaluronic acid (Juvederm family, Restylanefamily, Voluma, Belotero), Calcium hydroxylapatite (Radiesse), and Poly-L-lactic acid or PLLA (Sculptra). Among the non-absorbable fillers, Polymethylmethacrylate beads or PMMA microspheres (Bellafill) which are suspended in cow collagen hold a lot of promise and is widely used in the treatment folds and acne scars.
What Are Nasolabial Folds?
Nasolabial folds run diagonally from the side of the nose where it is wider to the side of the lips as it tapers off. These lines are formed when there is decreased skin elasticity, loss of soft tissue, descent of cheek fat, and overactivity of the midface muscles. Anyone showing any degree of nasolabial folds at rest is a good candidate for filler treatment. However, aging can bring about laxity of the skin and there are times when non-surgical lift and adding volume won't be enough to tighten the skin.
FILLERS: The Approach to Diminishing the Lines & Folds
At Juvly, we like to take a holistic view of the face. For instance, we do not see lines or deep folds as crevices to be filled but as something that would benefit from a push towards the surface as the dermis is plumped up by filler or grows its own collagen and a lift which gives a natural stretch. We find the approach of using fillers of the right density and flexibility adds lift from within with effects that can be both instantaneous and sustained. A few of our favorites are Voluma, Sculptra and Restylane Refyne. The choice of fillers is guided by the shape of the face: for a thin or athletic face we tend to use Sculptra, while a more full/round face benefits more from Voluma. One important TIP: do not go for total obliteration of the fold because this is a natural contour.
Most of the fillers contain Lidocaine and patients can elect to have additional anesthesia.The dosage of fillers depends on the anatomy, age, depth of lines and degree of volume loss. Injectors can choose to inject at mid-deep level of the facial skin or go deeper to the subdermis. If static nasolabial folds persist, addtional HA filler is usually enough to softent the lines during treatment follow-up. For deep dynamic lines, combination therapy woth Botox may be helpful.
Popular Dermal Fillers for Nasolabial Folds & Marionette Lines
I. Hyaluronic Acid
1. Restylane ® Refyne from Galderma are hyaluronic acid gels made with XpresHAn technology which makes it
more natural and softer than than Restylane. Defyne has more structure than flexibility and is more suitable for
deeper laugh lines.
2. Juvederm Vollure XC from Allergan has recently been approved by the FDA for "moderate to severe
facial folds and wrinkles including nasolabial fods". Made with Vycross technology it is a gel which is
firm enough to fill lines but supple enough to maintain expressions. Apparently, the "Stepford Wives"
belong to the past! ( Note: Juvederm Vollure XC is also known as Juvederm Volift in Europe)
Juverderm XC lasts for a year while Juverderm Vollure XC lasts for about 18 months. An all-time favorite at
Juvly is Voluma.
3. Belotero made by Mertz Aesthetics targets the fine lines around the mouth, commonly called smoker's lines. It
is perfect for moderate-severe vertical line around the mouth area. It is a "smooth and flexible gel" that
instantly bonds to skin to soften nasolabial lines.
II. .Poly-L-lactic acid (PLLA)
Sculptra, made of PPLA is so versatile that it is used as collagen stimulator on the face and on the
buttocks where it mimics the effects of the Brazilian Butt Lift (BBL). It can "correct shallow-deep facial
wrinkles and folds", not by instantaneously filling up with volume, but by replacing lost collagen
over time. Unlike fillers that push up the skin, Sculptra builds up more deeply. Results can last upto
two years. It is also made by Galderma.
Aging is not funny but laugh lines may now be a thing of the past. Modern Science has given us many fountains of youth in the forms of inectible fillers and neurotoxins. A thorough assessment helps the skilled injector to target with greater specificity what you need to look more naturally refreshed.
1.Attribution: Photo heading: https://www.flickr.com/photos/58842866@N08/5388146683/
2. Photo credits Mark Lambert: https://www.flickr.com/photos/43738859@N00/6337749796/
3. Hyaluronic Acid in the Management of Facial Aging
5. Alam, Murad & Gladstone, Hayes & M Kramer, Edward & P Murphy, Jack & Nouri, Keyvan & M Neuhaus, Isaac & Spencer, James & Spenceri, Elizabeth & Van Dyke, Susan & I Ceilley, Roger & K Lee, Ken & Menaker, Gregg & D Monheit, Gary & S Orentreich, David & Raab, Benjamin & C Smith, Kevin & Solish, Nowell. (2008). ASDS Guidelines of Care: Injectable Fillers. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]. 34 Suppl 1. S115-48. 10.1111/j.1524-4725.2008.34253.x.