Thank you for your question.
You state in your question which you submitted with a photo that you had 2 syringes of Juvederm
placed in the nasolabial folds and in the lips.
And you’re concerned that the nasolabial folds tend to be uneven even after placed
with a filler and you’ve been told that one side of the face is wider than the other.
You are asking about how this may be dealt with moving forward.
Well, I can certainly give you my perspective as a specialist.
I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and
reconstructive surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years.
I do a lot of injectable fillers for mostly facial aging-related changes and I use Juvederm
as well as other fillers to help people with this but I think that in a situation like
yours, I’m going to be able to share with you how I explain to people what the nasolabial
folds are relative to the global issue with the facial asymmetry.
So to begin with, you are certainly on the right track.
It is very well known in our field that one side of the face is not the same as the other
side of the face.
It is always one side that is a little bit more recessed.
Maybe sometimes it can be wider, a little bit different but there is natural asymmetry.
But another important factor and that asymmetry is based on, going back to that concept, it’s
based on bone structure.
Bone, muscle, fat, everything revolves around the structure of the bone.
So that being said, when people noticed that their nasolabial folds are getting deeper,
very often they’re concerned about softening those nasolabial folds and the same thing
with the marionette lines.
And I’ll often ask them what do these lines really reflect and what they reflect is volume
loss.
So when we look at people from a global perspective of bone, muscle, fat, soft tissue, we often,
in addition to dealing with the filler and the level of the lines, we also deal with
the structure and we do a procedure called structural volumizing.
What this means is the materials such as Juvederm, such as Voluma are placed directly over the
bone structure in a way that is under the muscle and actually provides support that
can help compensate for different levels of asymmetry and further enhance the appearance
of the nasolabial folds.
When you think about it, a lot of very young people have deep nasolabial folds.
Why?
Because that’s the way their structure is and not because of aging.
So we do this procedure where we restore cheek volume, jawline volume and then very often,
you don’t even need something to improve the nasolabial folds because the volume correction
has restored balance to the face.
When you look at the nasolabial folds, you have to think this is a line and the skin
in this line is relatively thin and there are deep attachments.
So the amount of filler you can place there is subject to the elasticity of the tissue
and the ability to really elevate and there is an upper limit.
There is always a limit of how much material you can put under the lines, as well as into
the dermis which is the back bone of the skin which is very thin.
So learn about this concept about structural volumizing and think about that in a global
picture.
Basically, take a step back and look at your face.
Would there be benefit putting volume in the cheek area?
Would that help balance the area out?
I’ve noticed that a lot of times, patients will focus on lines and sometimes miss the
forest for the trees.
And so, when we do our evaluations, we actually put their photos up.
We have them see what we see as someone who is meeting them, let’s say, for the first
time and look at the overall balance.
And very often, restoring volume in the critical areas where volume is lost actually balances
everything out and the nasolabial folds don’t look as deep as they initially did.
So I hope that was helpful, I wish you the best of luck and thank you for your question!