Aspen, Colo. – At this summer’s edition of The Cosmetic Bootcamp (CBC), Newport Beach, California-based plastic surgeon Val Lambros, M.D., FACS, shared tips for effective filler injections.
He asked, “What happens to the nasolabial fold with cheek filling? You hear all sorts of outrageous statements that if you put a little filler in the cheek, it pulls the face up. Or ‘my results are better than yours because I put one cc in front of the ear, and it pulls the face backwards.’ Is this just marketing and wishful thinking?”
Dr. Lambros demonstrated that the primary effect of fillers is expansion, not lifting. He showed several slides of older patients who required expansion of the lower cheek, which had no effect on nasolabial folds.
Conversely, one male patient showed improvement. “Thin people are said to have worse nasolabial folds, but it’s not necessarily because of the crease. In a thin person, the lateral side of the nasolabial fold looks like a rope – if you only see one side of the nasolabial fold, it looks better than if you see both. I filled in all the way to the lateral side of this patient’s NLF (the crease). That makes the area look better. But it’s not a traction effect. It’s a local effect of lifting directly under the folds. And when you make parts of the face look better, it seems you can make the whole face look better.”
Why does the nasolabial fold look better with cheek injections in some people? “Partially it’s illusion – if the cheek looks better, the fold looks better. I believe it draws away the eye.”
It’s also important to consider what’s appropriate for the patient’s age. “All of my patients are older. You must fill older people differently than younger people. With older patients, you fill hollows. With younger people, you can get away with filling prominences, such as beneath the cheek bone. If you do that with an older patient, it looks terrible. The face always tells you what to do. But you must listen to what the face is telling you.”
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