Placing filler in the nasolabial folds, also known as the smile or laugh lines, is a procedure that is not just overrated, but, in fact, works to a patient’s detriment more often than to her benefit. First off, a significant nasolabial fold can, in fact, be a feature of stunningly beautiful faces; check out the “smile lines” of Kate Middleton, for instance. For some patients and medical professionals who inject fillers, this obsession with filling/overfilling the “smile lines” produces a face that begins to take on a chimpanzee-like appearance. On the other hand, deep smile lines of aging are actually the consequence of a problem farther up the face – descent of the upper cheek fat pads. Therefore, by careful attention to the underlying cause (descent of the upper cheek fat pads and changes in skin texture), nasolabial fold-softening can be achieved in more natural-looking and beautifying strategies, such as:
1) Improving the quality of the skin around the mouth by tightening and thickening the tissue and skin with energy devices such as fractional CO2 laser, radiofrequency microneedling, and/or chemical peels.
2) Adding back volume to the upper-outer cheeks by skillful use of fillers or fat grafts. This returns a more youthful heart shape to the face (think of Angelina Jolie’s beautiful upper-outer cheeks and heart-shaped face).
3) Facelifting and mid-facelifting with under-layer-lifting of jowl fullness back to the upper-outer cheeks is, in more significant aging faces, an ideal way to restore a more youthful facial shape and soften nasolabial folds in a long-lasting, natural-looking way.