Dermal Fillers for Nasolabial Folds
Nasolabial fold filler can be used to lift and treat these folds, which occur with ageing and volume loss in the cheek area. Nasolabial folds are the lines from the lower nose corner to the corner of the mouth which make the face appear more aged
Filler injections will make the area look smoother and younger, with less of a demarcation between the cheeks and the lower face.
Many patients are concerned about the appearance of their nasolabial folds, even from a very early age, and this concern intensifies over time. They can be concerned about the fold, or the wrinkle or both.
Dermal filler can be used to address these issues.
Please see research on the topic of classification of nasolabial folds for fillers
The nasolabial fold filler debate
There is debate about whether nasolabials should be filled. Those against filling the nasolabial fold argue that the nasolabial is mostly caused by volume loss in the cheeks, causing loss of structural support for the cheek, causing it to “fall down”, creating the nasolabial fold. So they see the nasolabial as a symptom of volume loss and believe that volume in the cheeks should be replaced, which is treating the cause, rather than treating the symptom, which is the deepening appearance of the nasolabial fold.
Where we sit on the debate: In practice, it is very easy to fill a nasolabial fold and the patient does appear younger after this treatment is performed. BUT if that person has volume loss (which they invariably do) then filling the nasolabial fold is not recreating this person to look like their younger self. It is just filling in a fold. The other point is that it takes significantly more product to fill a cheek than it does to fill a nasolabial fold. So there are budgetary issues to consider as well. Also, too much product may be required in the cheek to reverse a nasolabial fold, and this can create an unnatural pillow-face appearance. Our recommendation is to treat both the cheek and the nasolabial fold to obtain the best appearance, in these circumstances, if it fits into the patient’s budget. If the budget doesn’t allow for all treatments then cases should be assessed individually to see whether treating volume loss or the fold will make the biggest or best and most natural change to the person’s appearance.
TREATMENT OF NASOLABIAL FOLDS WITH DERMAL FILLERS
Choosing the type of dermal filler for the nasolabial fold
We use several different types of nasolabial fold filler. We cannot use their names due to Australian regulations, which makes it difficult to talk about how they compare to each other and the pros and cons of each.
Reversible dermal fillers are safe and well tolerated, with great results. For nasolabial folds dermal filler with a larger particle size, or lifting capability is useful, but in older patients with thinner skin, a smoother filler may be required.
Biostimulators are also an excellent choice for the nasolabial fold.
Dose of nasolabial fillers
The dose required for nasolabial fold filler is variable, it depends on the patient’s anatomy, and where the patient wants to get to in terms of results.
The doctor will assess the nasolabial folds and decide on the best dose after taking a history and examining the patient. If a patient has a history of complications with dermal fillers, or if their budget is small or if they want a more subtle result, then a smaller dose might be chosen to start with.
We may use a standard protocol for first line dermal filler treatment of the nasolabial fold(when treated on its own), which is
Treatment 1: 1ml dermal filler
Review at 1month after treatment. If nasolabial fold adequately filled then treatment should be at 6 months, 6 months then yearly. If at 1 month review results not adequate another 1ml of dermal filler will be injected, with another review at 1 month.
Pain relief during treatment
A numbing cream (eg EMLA or LMX or compounded topical ) may be applied to the area prior to the nasolabial fold filler treatment (45 minutes prior is ideal) Glad wrap may be used over the numbing cream to increase its effect.
If a cannula is used, local anaesthetic is used prior to the cannula being introduced into the skin.
There is local anaesthetic in the dermal filler
Ice may be used to decrease pain and to reduce the risk of bruising.
A dental block with anaesthetic to completely numb the nasolabial folds is provided as an option. Although this isn’t ideal as it may distort the shape of the nasolabial
Nitrous oxide (happy gas) is available for patients to use
What happens during the nasolabial fold filler treatment itself?
The area will be cleaned with alcohol.
Ice will be applied to the area briefly before treatment The doctor will inject using a very fine needle. Then pressure with gauze will be applied.
If a cannula is used, a small injection of local anaesthetic is injected into the skin and then a fine needle makes a small hole in the skin where the cannula is inserted.
Side effects /risks with dermal fillers in the nasolabial folds:
Bruising: occurs in a significant number of cases.
Swelling: in the injection area will occur. This will last for approx 48 hours
Tyndall Effect:Blue appearance of the dermal filler under the skin
Lumps:Our 3 session technique reduces the incidence of lumps
Asymmetry: Sometimes one side is better treated than the other, this is usually because the patient is asymmetrical to start with. Nasolabia folds are notoriously asymmetrical. Most patients will have different doses to each side of the nasolabial folds
Infection is a very rare complication, but always a possibility when the needle goes into the skin.
Necrosis: (blood vessel being blocked, interfering with blood supply to the skin) is very rare. This could lead to scarring.
Blindness: A rare but devastating complication. We use techniques to minimise this risk
Need for further treatment: It may take several syringes of product to get to where the patient wants to be with nasolabial fold filler.
After nasolabial fold filler
Instructions for care afterward
No makeup for 4 hours
No heavy exercise that day
No acid face products for 24 hours
No spas no saunas, no hot yoga for 1 week post treatment
What to expect after the nasolabial fold dermal filler treatment?
The effect of the nasolabial fold filler will be obvious immediately.
There may be redness and swelling, and red dots at the injection sites. Bruising may occur. If cannula is used, bruising is less common
Most of the swelling from the dermal filler will have resolved by 2-3 days after the procedure. There may be a small amount of swelling for even 2-4 weeks after the procedure.
Bruising will last 7-8 days
What if I get asymmetry at some time before the 4 week review? Do I call the doctor?
Most nasolabial folds are asymmetrical to start with, your doctor may aim to improve this symmetry, depending on the goals fo the treatment. In the early stages after a treatment, sometimes asymmetry will occur because one side is more swollen or bruised. Usually it will right itself by the time of the review appointment. If it doesn’t, then it can be examined at the review appointment. There is no point in coming in early for treatment of asymmetry as there is often swelling associated and so the final result cannot be seen until at least 4 weeks. Treating asymmetry too early could lead to further and worse asymmetry
How long will the treatment last?
The answer to this is very individual and depends on the patient’s anatomy, metabolism, the dose, the placement, the product etc.
With the dermal filler that we use, the protocol is a treatment today then 6 months, then 6 months then yearly
Cost of dermal filler in nasolabial folds:
Cost is per syringe. Our most commonly used dermal filler, cost is from $750-$800 per ml. 1ml is used per session.
Biostimulator cost is by vial, prices for 1 vial are from $890
Case studies dermal filler nasolabial folds
Reduce Smile Lines Around Mouth with Dermal Filler
It is important, especially from a preventative point of view, to reduce the smile lines around mouth. These lines which occur on smiling and are more vertical, in the lower cheek area, are sometimes called “accordion lines”. The best treatment to reduce these lines is dermal filler. These lines are adjacent further outward on the face than the nasolabial folds, the lines from the nose down to the corners of the mouth. These nasolabial folds should also be treated with dermal filler.
Why is it important?
Treating the accordion lines in the lower face is vital at an early age, the reason is that once these lines become moderate to severely etched, they become very difficult to treat.
The problem with these lines are that they are coming from so many different areas. They are affected by midface and lower face bone and soft tissue loss with ageing, and they are also affected by skin ageing from multiple causes and from the repeated smiling expression on our faces.
What can we do to prevent these lines forming?
- Antiageing face creams topically e.g. tretinoin, AHA etc
- Volumising treatments with dermal filler
- Skinboosters injected in the area
- Dermal Filler injected under the wrinkles
- Regular laser treatments
What if they are already etched in?
The above preventative treatments should be performed urgently, as they are only going to get worse, which gets more difficult as time goes by.
What dermal filler technique is used?
For the volumising, an injector can take their pick, as long as they get enough product in. The volumising has to occur in the mid and lower face in the areas of bone and soft tissue loss. The amount used is going to depend on how much volume loss has occurred, also a patient’s budget (as a lot of mls are generally required)
For the injecting down the dynamic lines themselves, I use a combination of fern technique and also just getting the filler directly into the lines to lift them along their whole length, done really old school, like we did in the days of Collagen.
Cost of the filler treatment?
If volumising is required, then this is going to be the expensive bit.
If skin boosters are used (which I highly recommend for prevention!) then the cost is about $450 per ml. 1-2 mls will be required.
If dermal filler is used for injecting down the smile lines themselves, 1 ml can go a long way with the fern technique, so the cost will be starting from $750