Injectable fillers, like Botox, have revolutionized the approaches used for non-surgical facial rejuvenation. While Botox is a paralyzing agent for decreasing expressions, fillers are for adding lost volume or volume that one never had. While each has its own specific facial uses, they are often used in combination for a more significant facial effect.
Injectable fillers are a ‘southern’ facial or perioral treatment method with its major uses being lip augmentation and nasolabial fold reduction. Its use in the nasolabial folds, also known as the facial parentheses, is an actual FDA-approved indication and is so marketed therefore. Lip enhancement is widely done with fillers but is actually not a formally FDA-approved indication.
Injection into the nasolabial folds is a very valuable and effective method of temporarily softening their depth. Deepening nasolabial folds is primarily a female concern and a significant one that is associated with an aging appearance. There often exists, however, a discrepancy in expectation for this injection procedure that is in contrast to that marketed and promoted by the manufacturers.
Promotional advertisements and representative patient results from the various filler manufacturers will usually show a dramatic and near complete (if not complete) elimination of the nasolabial folds. Often the folds are shown to be completely gone. While there are some patient results in which this kind of result can actually be obtained, it does not represent the majority. With the usual use of one syringe per treatment session, which is what most patients are willing to pay, some reduction of the nasolabial folds is always obtained. While this result will satisfy many patients, there are clearly some that it does not. They will either never repeat the experience and will not be seen again…or come back to discuss their dissatisfaction with the results.
Patients are understandably misled by showing results that demonstrate the best case scenario. While doing so has obvious marketing advantages for the manufacturer and provider alike, it could be construed as misleading. One’s best results are not average results. This is where time spent on patient education and expectations is important. Better results can always be obtained by more volume or ¾ to one full syringe per side. But this may be too costly for most patients for a treatment that will not last a year. Letting the patient know that the results are based on volume injected and that the initial treatment will involve only one syringe is important. More volume at increased cost can always be done later if the results are not enough.
There are other options for nasolabial fold augmentation including autogenous and synthetic implants and even excision in the rare patient. Having a patient discussion about the range of treatment options and choosing a value-oriented approach for the long-term is a useful patient service.
Nasolabial fold injections are not a magic eraser or will not usually result in complete elimination of their presence. Until more permanent injectable fillers that have safety profiles comparable to the more temporary ones are developed, patients need to be willing to accept a temporary mild to moderate reduction in their depth.
Dr. Barry Eppley
Indianapolis, Indiana