Thank you for your question.
You submitted your question without a photo.
And you describe in your question that you have deep lines from the nose to the lips
and that you want to know if fillers can help you or do they make your face look puffy.
Well, certainly I can share with you my approach in my practice to patients, this area is a
very common concern for them in my practice even though I don't have a photo of yourself
to give you more specific detail.
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.
The lines you are describing are called nasolabial folds.
And the approach to nasolabial folds is something that someone like myself whose practice has
been focused on helping people with facial aging, I have seen quite an evolution in the
understanding of the approaches to managing these areas.
And it’s often referred to as parentheses lines.
This is an area that a lot of people find themselves focusing on when they look in the
mirror.
And it’s a perception that deep folds are equal to aging appearance.
So I try to educate my patients on looking at their faces from a more global perspective.
A lot of times, people look at themselves at detail and miss the forest for the trees.
So when you look at younger people, people who are in their teens and 20s, you will see
that many young people have deep nasolabial folds.
So what makes it a situation for someone who is noticing their folds as getting deeper
and equating that with aging?
Well, there are a few things.
One major thing that we have certainly appreciated is the loss of volume in the face with facial
aging.
And with facial aging, bone loss, fat, soft tissue loss can make the folds look relatively
prominent.
Typically, when someone like you is asking will fillers help or will it make your face
look puffy, it is often based on what people see when they look around at either other
people they come across socially or when they go shopping or looking at celebrities.
And so, the challenge is when you look at the fold, it is really tempting and it is
really the standard for a doctor to say, “Well, if you have a line, I’ll put a filler to
fill the line because that’s what you do.”
It is a strategy that is certainly logical and rational but at the same time I would
say is limited.
What a makes a face look puffy when fillers are placed?
Well, what makes it look puffy is when there’s also too much filler in an area and is a common
problem that when it’s placed in the nasolabial fold, it shifts, it moves around.
And the fold is actually very tight.
So I often look at my patients and what I do is that during consultation, I take a lot
of pictures and I put those pictures on the screen.
And when I take those pictures and I put them on the screen, I show the patient the nasolabial
fold but I’ll also show them volume loss that is typically associated with the deepening
of the nasolabial fold.
And what is that?
It’s a loss of cheek volume.
It’s loss of structure that defines the cheekbones.
We have patients who have come to me complaining about the nasolabial fold and I would do a
procedure called Structural Volumizing where I place a filler, a long lasting hyaluronic
acid filler such as Juvederm Ultra Plus and Juvederm Voluma and I place it in the bone
structure.
Now this is in contrast to placing it just under the line which is typically done just
below the skin or within the skin, what is referred to as a subcutaneous or intradermal
placement.
When it's placed at the bone structure, it’s placed between the bone and the muscle.
What that does it restores volume where volume is most significantly lost.
Now by doing that, for example in the cheek area, when that is corrected, the nasolabial
fold doesn't look as deep.
It is not unusual for me to put volume more significantly in actual milliliters in more
larger amount at the cheek level and put a limited amount at the nasolabial fold.
That way, you're dealing with both the underlying issue as well as softening the depth of the
line.
So to answer the question about will it make your face look puffy, well it depends on how
the procedure is done and what is the global understanding of the doctor who is going to
do the procedure for you.
I think the take home message here is, it’s important to look at the big picture.
Look at your whole face and see what is it in addition to the fold especially in the
cheek area that might be contributing to the perception of the deepening of lines.
You know, the whole beauty industry is all about chasing lines.
But what I think is an important take home message is the lines are really just a part
of the presentation.
But what we want to do is deal with the underlying structure to get the most benefit to create
the most harmony in the facial volume.
You know, when people get lines filled, they can look improved but I propose that it’s
rare for someone to get a, “Oh my god, that’s an amazing result” kind of impression.
When you restore volume in the right places, whether it’s the cheek, whether it’s the
chin, whether it’s the jawline or jaw angle, those people in our practice, when they look
at themselves, they’re often very impressed with the outcome.
It’s not just the line, it’s the whole face and how it looks more youthful.
So meet with qualified, experienced doctors who perform a lot of injectables.
Learn about their approach.
Sometimes you have to try different ways before you find the right chemistry that is between
you and the physician who you work with.
A lot of my patients have been with me for decades.
And for me, it’s more about a long-term strategy and relationship where we deal with
various things including injectables, lasers and other solutions as the issues come up.
But I feel it’s important to find a doctor who could be your primary care doctor for
beauty so that you can deal with things as they come up and learn also about things that
always get presented in the market place and add more opportunities to improve your appearance.
So I hope that was helpful, I wish you the best of luck and thank you for your question.