Thank you for your question.
You submitted your question and you describe a situation where you had fillers done for
your smile lines two weeks prior.
And you say that you had initial improvement and now the smile lines came back.
In addition, you say that you had filler placed in your cheeks to add more tension, to help
improve the smile lines and you are frustrated that you spent money and the smile lines have
come back.
So you’re trying to have some understanding of what is happening.
Well, I can certainly share with you my approach to this area and the consultation process
that I have with my patients who have similar concerns in my practice.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
Injectable fillers are very big part of my practice.
This is for every area you can think of in the facial volume whether it’s for cheek
volume, whether it’s for nasolabial folds, whether it's for chin as well as for lips
and the under eye area.
This is something we do a lot in our practice.
And I think it’s very important for you to actually have some guidance with your doctor
as to what was the expectation as to the degree of improvement and I think this is important.
When I talk to patients about this particular area that is very commonly of high concern,
people feel that that area makes them look much older.
And I would say that it is something that I address particularly on people who have
facial aging changes.
And that’s in contrast to people who are relatively young.
The reason being is that when you think of this particular area, the anatomy of this
area is actually something that is frequently discussed in our field.
And the anatomy is such that it represents that particular line, represents an area where
several facial muscles actually are attached.
Further, at the deeper level, there are important connections and blood vessels.
So it’s an area that doesn't just pop away.
And I would also ask you to think about what did you look like before the procedure.
And I think it’s important to review this with your doctor.
I think that, a lot of times, people want to see something disappear completely but
when you review the photos, you might see that there was some improvement.
Now when it comes to this area, there is certainly a wide range of opinions about the best way
to treat this area.
A lot of my colleagues would even say that they wouldn't even bother treating this area
because it’s frustrating to manage this area.
Well, what I would say is that when I look at this from a facial aging perspective, I
look at the global facial aging process.
And you did address some of that with the cheek volume and I think you are on the right
track.
When I look at someone who has a concern about this type of issue, I often employ a technique
called Structural Volumizing where I place volume at the bone level, at the cheek area
and that actually, when it restores harmony, makes the nasolabial fold look better.
Now it is pretty common for me to combine the placement of filler on the cheek with
some filler at the nasolabial fold level and it depends on what I perceive as a relative
hollow in bone volume.
Without getting into the details of the particular anatomic structures, I would say, as you go
higher on the nasolabial fold, there is a potential space that is more amenable to volume
correction.
I think a lot of my colleagues get frustrated and their patients get frustrated because
the filler is placed just under the skin which means with movement of the facial muscles
which are attached, the material moves and shifts.
And when it’s placed at the skin level or intradermally, well then it kind of looks
like a narrow band.
Now that being said, I think the best candidates for this type of filler are people with either
a genetic volume deficit or a significant amount of age-related volume loss.
So I think it’s important that you review your photos with your doctor.
Look at the big picture also.
Look at your facial anatomy.
I’m confident that with the cheek volume improved, you may see that the contrast of
the cheek to the nasolabial fold and the harmony of the facial balance has probably improved.
And I think it’s less realistic to expect those lines to be completely gone.
I think that yes, you initially may have had a better correction because there was volume,
that there may have been an element of swelling and it is something that I do in my practice
routinely is to see my patients two weeks after an injectable filler to see how they
look and learn what is their particular response to that filler.
And we get to review what they look like before and what they look like after to get a sense
of how successful the result was.
And I think it’s important to have that kind of dialogue and relationship with the
doctor you have chosen to do your fillers.
I think it’s important for the doctor to learn what is right and optimal for you.
If it turns out that this is not the best way to allocate resources, it may be better
to look at the whole face and see what other things you can do to help you look your best.
So I hope that was helpful, I wish you the best of luck and thank you for your question.