It’s all about the cheeks


I’m going to start this off by saying I HATE injecting Nasal labial folds (NLFs).  I cringe every single time someone comes in and says that is the #1 thing that bothers them when they look in the mirror.  I will also tell you that I rarely inject them and here is why.

When a “normal” person (and by normal I mean someone not trained to use their aesthetic eye) looks at their face for sagging and drooping, they often see it under the eyes, the NLFs and the jowls.  They start to look sad and tired.  These areas drive them nuts and their thoughts are consumed by wanting these fixed.   So now you are sitting in my chair and I hear what you are saying, but I am seeing a completely different thing.

When we were children we had these chubby cheeks that jealous adults just wanted to squeeze.  I have always had a round chubby face and I can remember asking Dr. Witzke if he would lipo the fat out of my face.  “No way, you are so lucky to have that fat.  You just wait and see.  When you are 40 you will be so happy you didn’t!”  And he was absolutely right.  As we age…..gravity (the damn G- word) takes a toll on all of us.  No one is immune!  We lose facial volume, the facial bones start to shrink, and the muscles aren’t as toned.  Everything starts to slide south!  That is where everyone sees it.  It’s hanging south.  So you want me to fill it?  Let’s imagine that I do.  I fill in your NLFs and puff it all up.  It will most likely take 3 syringes of filler.  I can smooth out the creases.  I have seen it done to people many times.  So what is the result?  It is what I like to call the “monkey mouth.”  All I can focus on is your mouth and your teeth as you’re talking to me.  Your lips have curled inward and you no longer look like yourself.

So what’s the real solution to NLFs?  The answer, most of the time, is cheeks.  Thank the Lord above that he gave a scientist the knowledge to create cosmetic fillers (and Botox, but that’s a different blog).  Adding cosmetic filler to the midface and cheeks will give an amazing rejuvenating result to almost every human being I have met over the age of 30.  The best part is that it rarely bruises, and you can go back to work immediately without anyone knowing what you just did.  You know what they notice?   That you look happier!  Because they see these cheeks that look like you’re smiling, even when you aren’t.  Filling up those cheeks has pulled everything back up into place.  It’s almost as if you had a facelift.

Now speaking of facelift.   Fillers do not replace a facelift at all.  If you are sitting in my chair and you take both of your hands and pull your face back and say “this is what I want to look like!”  Then sweetie, you are wanting a facelift and you will be seeing one of my surgeons.  I am very honest with my clients about what results I believe I can achieve.  I spend your money like it is my own.  If I’m looking at you and I think we need 4 syringes of filler to just start off with……I’m not going to treat you.  I want you to talk about your surgical options too.  Me filling you full of thousands of dollars of filler may be better spent on a facelift that will last much longer.  Maybe you don’t want surgery at all, but it is definitely something we will be discussing.  I would rather have one of my doctors see you in a consultation before filler than after.  Even after a facelift, cheek injections are still a good thing.  They work wonders when done together.

The second complaint with NLF’s is the etched crease.  There is no volume loss just a thin line.  Often there are other smile lines associated with them.  These are a pain to treat.  My rule of thumb is, if I can spread the line apart and I still see the line….it’s going to be very hard to erase.  Those are lines caused by animation, which is smiling and expressions we have while talking.  Putting filler in there can fix it short term, but you are still going to be smiling and laughing.  That is going to push the filler out of the area.  Fortunately there are more and more fillers coming on the market that can be injected very superficially.  Other treatments for these etched lines are skin resurfacing such as laser, medical grade skin care products, chemical peels, and micro-needling.

The best advice I can give is to come in for a consultation.  Know if you are open to discussing surgical options as well as less invasive options such as cosmetic fillers.  This will help you decide if your appointment is for a surgeon or for a nurse injector.  If you want to have injections on the same day of your consultation please read the blog about preparing for your cosmetic injections.

To learn more about this topic or to schedule an appointment contact us at:

Plastic Surgery Associates of South Dakota, located in Sioux Falls & Dakota Dunes
4201 S Minnesota Ave #112,
Sioux Falls, SD 57105
612 Sioux Point Rd, Ste 600
Dakota Dunes, SD 57049
(605) 232-9720