I am a soon-to-be-31-year-old beauty editor, and, for as long as I can remember, I have considered my laugh lines to be no laughing matter. Many of us have a facial feature we fixate on. In my case, that feature has always been my nasolabial folds. Those parentheses-like creases look different on everyone. For the women in my family, they tend to run deep — and get deeper with age.
I mention the fact that I am a beauty editor because it means that I have long been spoiled by the opportunity to try great skincare products. I have a pretty solid routine that includes exfoliating acids to improve tone and texture, antioxidants to brighten and repair, and, of course, daily sunscreen to protect. But even the best lotions and potions cannot do much (if anything) to soften said folds. So, what’s a girl to do?
As I shared a couple years ago, I started getting Botox® injections just shy of turning 29 in an effort to get ahead of the increasingly omnipresent nature of my forehead lines. Last month, I headed to see Lesley Rabach, MD, a double board certified facial plastic and reconstructive surgeon, co-founder of LM Medical in New York City, and my go-to aesthetic provider, for a neurotoxin touch-up with nary a thought of doing anything else. During our quarterly catch-up session (she fills me in on all the interesting things she’s noticing in her practice and patiently answers my questions about some of the trends we’re considering covering here at The AEDITION), however, something compelled me to broach the subject of my stubborn smile lines.
As Dr. Rabach emphasized, some amount of creasing is necessary in the region — after all, babies are born with nasolabial folds — but there are both surgical (hi, deep plane facelift) and non-surgical (think: filler) solutions that can help soften their appearance. In my case, half a syringe of hyaluronic acid (HA)-based filler was all I needed to subtly yet substantially rejuvenate my face (keep reading to see before and after photos) for up to a year. Intrigued? Here’s what you need to know.
Returning to the Fold
Also called laugh lines and smile lines, the nasolabial folds run from the corners of the nose to the corners of the mouth. Look back at your baby photos and you’ll see that those creases have always been there. “Even children have smile lines,” Dr. Rabach shares. As such, “it is imperative to maintain a fold because without it, we look very unnatural,” she adds.
Depending on your anatomy, genetics, and lifestyle, however, the current state of your nasolabial folds may be quite different from their OG appearance. “As we get older, the cheeks lose volume and, together with years of smiling, the nasolabial folds deepen,” Dr. Rabach explains. Yes, smiling is one of the causes of deepening folds, which means those lines are a sign of a life well lived and laughed. While I can’t help but smile at that, it doesn’t totally reconcile my relationship with said creases.
From my teenage years through my mid-twenties, I always had a fuller midface. My nasolabial folds were fairly prominent then, too, but something about the overall proportion of my face seemed to camouflage them. By my late-twenties, my countenance bid adieu to any lingering baby fat, which added a bit more emphasis to those pesky parentheses.
It’s been in the last year or so, though, that I’ve noticed the most visible change. Doubling down on my fitness regimen, the stressors of everything going on in the world, and the anatomical realities of being a 30-something seemed to converge in a way that left my mid- and lower-face looking… blah. As someone who has always been conscious of my penchant for RBF (IYKYK), combining that with a leaner face and deepening folds made me look tired, stern, and just not like the best version of myself.
Fixing the Folds
Sitting in Dr. Rabach’s Greenwich Village office on an unusually mild December afternoon, I explained to her the evolution of my smile lines and, based on how my mom, aunt, and grandma have aged, forecasted the future of my folds. While she was quick to quip that my nasolabial folds were no deeper than those of her four year old, she did admit that a little HA filler could likely go a long way.
This is, she says, “a common area to be treated with dermal fillers,” but the placement of the product can be customized based on the patient and their aesthetic goals. “Nasolabial folds can be treated either by directly filling into the fold or by filling the cheek to lift the fold,” Dr. Rabach shares. “It depends on the individual anatomy which will be more natural and effective.”
I was more familiar with the latter option (augmenting the cheek for a more lifted appearance), but, as it turns out, I am not an ideal candidate at this point in my life. “Younger patients, where the folds aren't so deep, often benefit from a very small amount of filler placed just in the deepest area to soften that,” she explains. In my case, the deepest area was by the nose. Put another way: Because my cheeks are (relatively) full, it's better to inject into the fold. “If your cheeks were flat, then injecting into the cheek is better,” Dr. Rabach notes. Either way, the goal is the same. “The goal is always maintaining a natural amount of depth,” she reiterates.
Sure, cheek filler could help rejuvenate my folds, but it would also address a concern (cheek volume) that didn’t, well, concern me. As Dr. Rabach explained, the amount of filler I would need to see results, coupled with the fact that my goal was not cheek enhancement, made it inefficient from both a cost and benefit perspective. Instead, she said splitting a half-syringe of Versa™ by Revanesse® between my two folds would give me the subtly satisfying look I was after.
Fill ‘Em Up
Until now, my experience with cosmetic injectables has been limited to Botox®, which requires a bit of patience. Anyone who has ever gotten neuromodulators knows that it takes a minimum of a few days (and up to two weeks) to fully enjoy the effects of the wrinkle relaxers. Hyaluronic acid-based fillers, on the other hand, offer instant gratification.
While some areas of the face require numbing cream before filler injections, the nasolabial folds are not one of them. Dr. Rabach gave me a stress ball to squeeze, but, truth is, it hardly felt like anything more than a pinprick (there is lidocaine within the filler to further ease any potential pain). After two pricks into the upper part of the fold on my right side, she handed me a mirror to inspect the first half of the results. Much to my surprise — and delight — the crease was softer. She repeated the same thing on the other side and, in all of five minutes, I looked totally rejuvenated in the most understated way.
Dr. Rabach used Versa™ on me because, she says, “it is very versatile for the folds, moves with the person, and integrates well into the tissues.” Depending on the patient, however, she also likes Restylane®, Teoxane Teosyal RHA® 3, and Juvéderm® Ultra for this area. For most, HA filler results last nine to 12 months in the nasolabial fold region.
Recovery & Results
Regardless of the product, the most common side effects of HA fillers are temporary swelling and mild discomfort for a few days. As with any injectable, bruising is possible (though relatively rare in this part of the face). As you can see in my ‘after’ photos, I experienced a bit of redness at the injection sites for about 24 hours. After that, I found the area to be slightly tender to the touch (most noticeable when I washed my face) for about five days.
A month later, I am pleased to report that the results have exceeded my expectations. Not a single person — including my ever-observant mother, with whom I FaceTimed when I got home from my appointment — has been able to pinpoint what I had done. Yet, when I show them my B&A, the results are abundantly clear.
For some, the subtlety may be a letdown. For me, it’s the draw. Coupled with Botox® in my forehead and glabellar lines (the effects of which were not yet visible in these photos) and a skincare routine focused on keeping my combination complexion clear and radiant, nasolabial fold filler has offered a level of rejuvenation that I didn’t know could be achieved. For the first time in my life, I am smiling about my smile lines.
If you are curious about what you would look like with nasolabial fold filler, The AEDITOR — the patented 3D Aesthetic Simulator available exclusively in the AEDIT iOS app — allows you to ‘try on’ the procedure and instantly visualize medically accurate results. Download the app here, and, once you give it a try, consult with a board certified dermatologist or plastic surgeon to determine if HA filler is the right treatment option for you.
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