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Dermal Fillers for Nasolabial Folds

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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.

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Filler injections will make the area look smoother and younger, with less of a demarcation between the cheeks and the lower face.

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Many clients 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 issue.

 

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.

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Where I sit on the debate: In practice, it is very easy to fill a nasolabial fold and the client 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 clients’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

I 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 clients with thinner skin, a smoother filler may be required.

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Biostimulators are also an excellent choice for the nasolabial fold.

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Amount of nasolabial fillers

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The amount required for nasolabial fold filler is variable, it depends on the client's anatomy, and where the patient wants to get to in terms of results.

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We will assess the nasolabial folds  and decide on the best dose after taking a history and examining the patient. If a client 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 amount might be chosen to start with.

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I may use a standard protocol for first line dermal filler treatment of the nasolabial fold(when treated on its own), which is;

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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.

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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) Wrap may be used over the numbing cream to increase its effect.

There is local anaesthetic in the dermal filler

Ice may be used to decrease pain and to reduce the risk of bruising.

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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. I will inject using a very fine needle. Then pressure with gauze will be applied.

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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 2-3 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.

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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

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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

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How long will the treatment last?

The answer to this is very individual and depends on the client’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 £140 per ml. 1ml is used per session.

Please see prices of dermal fillers

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Biostimulator cost is by vial, prices for 1 vial are from £-

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appointment with Envie Aesthetics

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