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What Can Be Done for Nasolabial Folds?

smile-lines-treatments

Dear Nicki,
I have a question about nasolabial folds: Are there any products that can help in making them less pronounced? Or are there any ingredients that we should look for in creams/serums etc. that can maybe help in "lifting" these folds? Thank you so much!
-Francesca

Dear Francesca,

Nasolabial folds, also know as "smile lines" are the lines that run from the side of the nose to the sides of the mouth, separating the cheeks and upper lip. As you can see in the top photo, the left side is before treatment, and the nasolabial fold or smile line is very pronounced; the right side is after treatment, and the nasolabial fold or smile line is shallower and smoother. These lines are caused by the same factors that cause the rest of your skin to age, but there are ways to lessen their appearance.

There are three "tiers" of treatment in dermatology for nasolabial folds, from top to bottom according to price and availability. They are:

Top Tier: Surgical correction 


[Photo courtesy of Dr. Scott Spiro]

Not surprisingly, the most long-lasting and effective treatment for nasolabial folds is plastic surgery. The three procedures done most often to correct nasolabial folds are the mid-facelift, cheek implants, and nasolabial fold excision:

Mid-Facelift: If your cheeks are sagging, a mid-facelift (results pictured above) will likely be recommended, as this procedure lifts nose-to-mouth nasolabial folds as well as drooping cheeks.

Cheek Implants: If you would like more facial contouring, a small cheek implant often softens the upper part of the nasolabial folds, while giving more definition to the face.

Nasolabial Fold Excision: If you have severe nasolabial folds, a nasolabial fold excision may be your best bet. The nasolabial folds are literally removed from your face and the area is sutured afterwards.

Middle Tier: Fillers and/or Botox

[Photo Courtesy of Moore Eye Clinic]

By far, the most common treatment for nasolabial folds is a hyaluronic acid filler. There are three main classes:

Temporary Hyaluronic Acid Fillers: Hyaluronic acid fillers such as Restylane, Juvéderm (results pictured above), and Perlane, are typically injected into the mid-to-deep layers of the skin to plump up nasolabial folds. Results typically last for 9 to 12 months. While price varies by region, expect to pay upwards of $900 for this option (typically about $450 per syringe, with two usually needed).

Collagen Stimulators: Collagen stimulators, such as Radiesse and Sculptra Aesthetic, are for patients with less severe nasolabial folds. Think of Radiesse and Sculptra as best for gently rounding out an aging face that has been gradually losing volume for years. Results typically last for 6 to 12 months. Expect to pay a bit more, upwards of $1000, for this option.

Permanent fillers, such as Artefill, have the advantage of being, well, permanent. In addition, Artefill in particular has been FDA approved for use in the nasolabial folds. So why am I mentioning it last? The truth of the matter is, it is hard to correct potential complications as a result of using Artefill, so be careful in selecting your doctor or aesthetician. Make sure s/he has done the procedure before, particularly in the nasolabial folds, a region in which it is difficult to get the right symmetry. Ask to see photos of befores and afters. Another caveat: Artefill costs over twice as much as the other options, about $2100 and over for the average.

Bottom Tier: Retinoids, Glycolic Acid, Silicones

Even if you can't afford more than $100, don't fret: Scientifically-backed solutions are available in skin care products to treat nasolabial folds. Granted, these products will not typically produce the same results as the surgical procedures, but they also come with a far lower price tag — and far less risk. 

Retinoids: Consider retinol creams like FutureDerm Time-Release Retinol 0.5. According to research by Fisher et. al, retinoids are effective in preventing and treating the collagen loss caused by years of cumulative sun damage. Fisher et. al also demonstrated that application of tretinoin (a form of retinoid found in prescription Retin-A) stops matrix metalloproteinase genes from starting their collagen-degrading activities. So, I highly recommend prescription Retin-A or an over the-counter retinol like FutureDerm Time-Release Retinol 0.5

glycolic-acid-smile-lines

Glycolic Acid: You may also want to consider glycolic acid treatments, such as Glytone Boost Mini Peel ($54, amazon.com), in the area. According to a 1998 study in Dermatological Surgery, glycolic acid treatments increase skin cells' production of collagen better than other alpha hydroxy acids, including lactic acid or malic acid. However, if you’re deciding between prescription-strength retinoids and over-the-counter glycolic acid peels, you may want to choose the prescription retinoid: According to a randomized, placebo-controlled double-blind study, it was found that 0.05% all-trans-retinoic acid was more effective than 10% glycolic acid (a concentration found in at-home treatments) in treating signs of aging.

two-faced-wrinkle-injection

Silicones: Finally, no matter what, look for skin care products that contain silicones for use in the nasolabial area. These products temporary "fill" the area, making it look more cosmetically appealing. I like Too Faced Cosmetic Wrinkle Injection ($28). Though its ingredients aren't going to make you start producing collagen like the injectables Radiesse or Sculptra Aesthetic, the product's high concentration of silicones will still temporarily "fill in" your wrinkles, and also provide a more firm, solid canvas on which to apply your concealer and foundation — always a plus!

Bottom Line

The "right" treatment for your nasolabial folds, or smile lines, comes down to your penchant for spending money and risk-taking. Those high in both categories are likely to get surgery, whereas those on the opposite end of the spectrum should use Retin-A, get regular glycolic acid peels, and use a cosmetic product designed to be a filler with silicones as well. That said, most people choose the hyaluronic acid fillers right now, as these procedures have a high degree of satisfaction with a relatively low risk if you choose an experienced physician or aesthetician.

What are your thoughts on nasolabial fold treatments and wrinkle treatments in general? Let us know in Comments!

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*Editor's Note: This post contains affiliate links.

Date: May 13 2012 at 11:25 PM
Procedures, Skin Care, artefill, how to get rid of nasolabial folds, juvederm, nasolabial folds, nasolabial folds treatment, perlane, radiesse, restylane, sculptra, too faced wrinkle treatment, toofaced, retinol for smile lines, glycolic acid for smile lines, treatment for smile lines, lines around the mouth, surgery for smile lines, procedures for smile lines

Comments (6)

  1. Bk
    May 14 2012 at 3:04 AM

    In my opinion, the best way to tackle NL's if using filler is to have the filler injected in your cheek instead of directly in your NL's. If you split your cheek in half, right down the middle, have the filler injected in to the outer, high, portion of your cheeks. NL's are mainly caused by lost upper cheek volume which cause your cheek skin to sag down and form these NL trenches, if you replace that upper lost volume, it will lift that skin back up where it should be, reducing your NL's, plus give you back that fuller face youthful appearance. When I first started using fillers for NL's, I always had them directly put in my NL's, until I actually put 2 & 2 together and got down to the root of the problem....Let me just say, for myself, getting filler in the cheeks was a epiphany moment! NL's were decreased dramatically AND bonus you look more natural and youthful with replaced cheek volume!

  2. Bk
    May 14 2012 at 3:06 AM

    ...Let me also add that if your NL's are not decreased enough for your taste, you can always get a little bit of filler put in those as well. :)

  3. Josephine
    May 15 2012 at 10:38 AM

    What's the difference between the new Neutrogena Rapid Wrinkle Repair Night Moisturizer with Retinol SA, Glucose Complex, and Hyaluronic Acid -- and the Neutrogena Healthy Skin with Retinol??? Also -- do personally you used Green Cream Level 9 with Retinol, instead of Retin A because it's less irritating?

  4. Nicki
    May 22 2012 at 4:02 AM

    @BK - Very insightful comments, thank you. @Josephine - Neutrogena Retinol SA is designed to be time-release. Unfortunately, because it is "time-release," the formulation includes a lower concentration of retinol. I've tried them both - Retinol SA in passing, Neutrogena Healthy Skin for years as a teen and in my early 20's - and I'll say that I still think the latter Healthy Skin was better overall. As for your second question - honestly, I started with Green Cream Level 3 when the company sent me it when I first started my blog in 2007. I adored it! I don't know if it was because the product is great (because it is) or because it was the first product a company had ever sent me to sample, but it stuck. I gradually worked up to Level 6 (the next one up) and then Level 9, and I just adore it. That said, I do know the studies show prescription tretinoin is 20x more potent than over-the-counter retinol, so I will probably be switching over in the next couple of years. I don't know if you noticed, but I've been switching over to a lot more "clinical" derm procedures lately. As I'm nearing 30 (and my M.D.), I'm starting to value the option of more invasive dermatological procedures. I haven't indulged quite yet, but I'm certainly open to it. And I'll probably switch to prescription Retin-A soon. Hope this helps!

  5. Soi Dog
    December 28 2012 at 6:52 PM

    I note there is no mention of Futurederm time release retinol here or in the post I read on your site with product recommendations today. I have just ordered your futurederm product and now feel confused that your product is not ranked with the others you have selected as among the best??? Would you please advise, Thankyou

  6. tjham
    February 27 2013 at 1:01 PM

    Like Soi Dog, I wonder the same thing. I was interested in the FutureDerm product and now I am also confused.

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