How Deep Nasolabial Folds can be Treated with Long Lasting Cosmetic Filler, without Looking Puffy

How Deep Nasolabial Folds can be Treated with Long Lasting Cosmetic Filler, without Looking Puffy

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.


  • Nancy Long says:

    I truly enjoy your channel. Very, very informative. I could only ask if you could update your “before and after” pictures to show the results of whatever procedure you are speaking about. If I see those same 2-3 ladies one more time, ………….
    Incidentally, 1 or 2 of them, aren’t they the women in the pamphlet cover of Radiesse or something? Thank you for your response.

  • Vaishnav Reddy says:

    Hello doctor I suffered from body pains and high fever it took 2 days to recover and I’m losing more hair today is it normal ?

  • 23lolita2323 says:

    Very interesting. Thanks for the info!

  • Carrie P says:

    Excellent information! I never thought the filler in the nasolabial folds look natural! So how is the cheek filler procedure done?

  • Santi Vargas says:

    Hi and thank you for your videos. Do you know any Dr's you'd recommend in the Houston TX area. There are just so many places that do fillers and Dr offices.. I just wondering if Dr's have a network of those that practice like you would for example.

  • khan Rana says:

    Filler for cheeks how long does it last ??is it 100%safe??

  • tara cumming says:

    Can I make an appointment?

  • Palani A.Subramaniam says:

    Superb, wish you had a practice in Malaysia.

  • Ran Am says:

    Thank y Dr

  • JLS x says:

    I just had filler in the lines yesterday as I had an accident and it made the nasal lines worse and I waited a year to get it done after my accident and am now worried that the filler with shift as I didn’t have it done like you suggested – I had 1 ml each side and I’m so swollen like a chipmunk and look weird but I’m
    Hoping it is swelling

    Can I ask how long does swelling last as I look dreadful and I can feel it moving and was hoping that is just swelling

  • usho daya says:


  • Linja Skovgaard says:

    What do I do when my nasolabial folds are not a result of aging but genetic and I already have quite full cheeks?

  • Afsheen Bilal says:

    Dr Prasad I am highly impressed with your generosity in sharing your techniques. I full agree with your experience and techniques of placing filler on bone to restore volume. Less filler gives amazing results indeed. Thank you very much for sharing your knowledge.

  • Ariana R. says:

    I was skeptical to watch because you look 19! Wow!

  • Angela h says:

    Great video. I went to a very reputable surgeon in my area. I kept telling him i just wanted the lines filled on the sides of my nose. He took the time to explain much like you that its not just about the line but also about the volume loss and how filler in cheeks will enhance overall vs. filling lines on sides of nose. I had the procedure done with voluma and I am very happy. I am considering thread lift for the very bottom half of my face that filler didnt lift. What do you rhink of thread lifts?

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