Marionette wrinkles and nasolabial folds: causes and correction with fillers

When handling botulinum toxin, the practitioner will use the standard doses recommended for the type of product being used. However, the amount of dermal filler used to perform the correction depends on many factors: the desired result, the condition of the target area of ​​the patient, etc.

In this article Dr. Michael Aicken, based on his own experience, talks about the amount of filler needed to correct nasolabial folds and marionette lines, as well as the choice and techniques for introducing such drugs.

Why do nasolabial folds and marionette lines appear

The nasolabial folds and marionette lines are very similar: they form as a result of the natural aging process as:

•    Loss of soft tissue volumes in the central part of the face;

•    thinning and omission of the lateral part of the face due to changes in adipose tissue and a decrease in the elasticity of the dermis.

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To determine the amount of filler needed for correction, it is necessary, of course, to assess the depth of the folds. At the same time, it is important to understand that maintaining the balance – the main aspect of face beautification. Patient expectations, physician experience and patient budget – factors that also affect the amount of filler used.

Fig. 2: before (above) and 10 minutes after (below) the injection of 1 ml of filler into marionette wrinkles in order to replenish volumes and fill in folds

Techniques for correcting nasolabial folds and marionette lines with dermal fillers

The shadow that falls from the lateral to the medial face results in the dark line we see in patients with nasolabial folds or marionette lines. Smoothing out the differences in height between these parts of the face will partially remove the shadow and, accordingly, reduce the severity of these folds.

Patient expectations, physician experience and patient budget – factors that also affect the amount of filler used.

Fig. 3: Fat packs of the face, the age-related omission of which increases the severity of nasolabial folds and marionette wrinkles

This can be achieved using two techniques:

1.    bolus – it is best used in areas with the greatest volume loss.

2.    Linear – used for deep or superficial injection of the filler directly along the folds.

During injection, make sure that the drug is not injected above or laterally in relation to the folds, as this will increase the shadow (Fig. 4).

If the nasolabial folds and wrinkles of a puppet are compared with a comet (Fig. 1), then the "head" corrected using the bolus technique, and the "tail" – linear.

Read also: Contour plastic: injection of fillers into the nasolabial folds

As for the amount of filler, the author first injects about half of the total volume of the drug into the “comet head”, and then, based on the result, decides on the use of its remainder.

For example, if 1 ml of filler is required to correct both nasolabial folds, the author will first inject 0.2 ml of the drug into each "comet head". The remainder of the drug is administered in the same procedure using one or more of the following techniques:

•    deep linear;

•    surface linear;

•    cross;

•    bolus (at the base of the crease).

The author often uses the – inserts the filler into the dermis perpendicular to the direction of the fold. The drug can hold and support tissues, reducing their mobility. This technique can also be used to correct lines that become more pronounced during movement – perioral and lateral forehead wrinkles.

Choice of filler for correction of nasolabial folds and marionette lines

For the correction of nasolabial folds and marionette wrinkles, the author recommends the use of dense fillers based on cross-linked HA, since their task – resist the effects of gravity. Examples of such drugs:

•    Dermal Revolution DEEP;

•    Belotero Plus Intense;

•    Restylane Perlane;

•    Juvéderm Ultra.

Despite the fact that the duration of the effect of fillers is declared by the manufacturers to be from 9 to 12 months, the author notes that, as a rule, the result lasts longer. For example, if 2 & ndash; 4 ml of filler is used for the initial correction of deep nasolabial folds, a second correction of 1 & ndash; 2 ml of the drug is required after a year or even more.

Despite the fact that the duration of the effect of fillers is declared by the manufacturers to be from 9 to 12 months, the author notes that, as a rule, the result of correction of nasolabial folds and marionette lines lasts longer.

Read also: Safely inserting fillers: how to prevent possible complications

Of course, any procedure involves risks. With a bolus injection, the drug must be injected slowly and only after preliminary aspiration. Each time the needle tip is moved, aspiration must be repeated. Theoretically, this approach reduces the risk of complications.

Adapted from Aesthetics

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