Nasolabial Fold

Nasolabial folds, commonly known as "smile lines" or "laugh lines" are two folds that run from each side of nose to corners of mouth.  They are sort of static wrinkles. Several factors are related with formation of nasolabial folds, such as long term effect of laughing, losing elasticity of cheek tissue.  Toxin injection to paralyze part of laugh muscle is usually not recommended because toxin will affect facial expression.  Filler injection improves nasolabial folds in some ways, although the effect is temporary.  Below right showed the after picture of HA injection on nasolabial folds.

Tear trough, also know as "nasojugal fold", is a early sign of aging around eyes, leading a fatigued and aged appearance to the face.  Below left picture showed the location of tear trough and its relation with baggy eyelid.
For patients with tear trough and baggy eyelid, the best treatment is lower blepharoplasty.  For patients with tear trough but not associated with baggy eyelid, HA is an effective treatment.




Below case presented with tear trough and baggy eyelid. She chose to have HA injection on tear trough. Below right showed the after picture. Tear trough improved, but baggy eyelid persisted.


The possible side effect of HA injection on tear trough is roll formation, especially when smiling. Below case underwent HA injection at another clinic. One of the cause of roll formation is HA over-injection. Injection of enzyme which can solve HA ( hyaluronidase) is the way to improve this situation.



One of aging sign on cheek is midcheek groove( marked on the below picture with circle). Filler injection can improve midcheek groove. People with fuller cheek looks younger.




HA can be used to enhance smile roll. People with smile roll looks more friendly than people without it. Below left is before. Right is after picture of smile roll HA injection.





 

 In Oriental countries, oval face is kind of beauty standard. Bone surgery was the only way to slim face. Since the introduction of botulinum toxin, slimming face by toxin is more acceptable than bone surgery. The toxin is injected into Masseter muscles which are located on outer surface of lower jaw( refer to the below picture). After injection,muscles will shrink in size. There is no downtime and risk free. The effect lasts about 6 months.



Below right showed the after picture of toxin injection on masseter muscle to slim face.

For people who is not ready for rhinoplasty, filler injection to augment nose is another choice . Radiesse is a tough material than hyaluronic acid (HA) , so that Radiesse is more suitable to augment nose. Below showed the result of nose injection with Radiesse.


For patients who expect to have mild change on nose, HA is another choose for them. As shown in the case below. Right is the picutre after HA on nose. 



Filler is not strong enough to support nose tip, so that filler can modify nose tip a little bit. For people who want to have high projected tip, rhinoplasty operation is recommended. Below case underwent Radiesse injection on nose at another clinic (below left). She was not happy with the result, especially at nose tip. Below right showed the picture after two-pierce rhinoplasty. She is satisfied with the result.

   
Left: After Radiesse injection.                             Right: After rhinoplasty.

1.When toxin was injected on muscles, the injected muscles should be exercised in first hour after injection. So that the drug effect can be evenly applied. Such as when toxin was injected on Corrugators, frown should be done in first hour. When toxin was injected on masseter muscle, chewing gum should be done in first hour.

2.The botulinum effect appears in about 4 days. But you will feel that the masseter muscles become soft and the face becomes smaller in about 3 weeks.

3. When the toxin was injected on dermal layer, you do not have to exercise the muscles. You can feel the area brighter and firmer in about 1 week.

4.Although the muscles do not move after toxin injection, but if you subconsciously want to move the muscles, the toxin effect will be shorter. If you have poor eyesight and often frown and look at things, the effect of botulinum effect on corrugators will disappear early. Therefore, to have longer effect of toxin on masseter muscle, chewing gum( except the first hour after injection) and biting on hard food are not recommended.

5. When hyaluronic acid is injected on the same part as toxin, muscle exercise is taken in first half an hour.

1. Cold packing helps to reduce redness and swelling within 72 hours after injection, and change to warm packing (temperature should not be too hot, too hot may accelerate the loss of hyaluronic acid) helps to reduce bruises and associated swelling.
2. Do not press or massage on injection site within a month to avoid the displacement of hyaluronic acid. If you have been treated on tear trough, don't wear goggles when go swimming for one month.
3. If the finest hyaluronic acid is injected into the epidermis (such as fine lines of the skin), you can massage on HA sites(help to even the HA).
4. When you think the dose is insufficient, it is recommended to return to the clinic after 2 weeks and have an additional dose .
5. Do not go to any place that is too hot, such as an oven , SPA or steam room. Heat maybe accelerate the loss of hyaluronic acid. 

1. Immediately apply cold packing to the injection site to help alleviate the redness and bruises. It is recommended that intermittent cold packing is required within 72 hours until the swelling gradually subsides.
2. A few days after the treatment, the treated area may feel a little swollen and tender, which is normal. The redness of the skin may last 3–5 days, which varies from person to person. Normally, your skin tone will gradually return to normal within a week.
3. Warm packing since 72 hours after injection helps to reduce swelling and bruising.* The cold and warm packing are based on rest for 30 minutes after packing for 30 minutes.
4. Within one week of injection, avoid rubbing and pressing the affected area vigorously. Avoid going to high-temperature places or excessive exposure to sunlight until the swelling and redness subside.
5. Within 1–2 weeks of treatment, you will feel a sense of tightness at the injection site. After a period of time, the treatment area will become soft and then you see the natural and significant effect.

Q: One bottle of botulinum toxin is too much for a guest. The toxin can be left for a long time without loss of toxin effect?

A: The original botulism is prepared as powder, and normal saline must be added before use. According to current research, botulinum is considered fresh within one to two weeks after normal saline was added. We charge according to botulinum toxin units, not according to the amount of saline solution.

Q: How long will the effect of hyaluronic acid on nasolabial folds be maintained ? Should will I keep be injected?

A: The effect of hyaluronic acid on nasolabial folds is about half a year due to the constant movement around the mouth. If the patient feels that the effect on folds is good but HA is gone, they will come back to have another dose .

Q: Is it true that some websites say that subQ can be maintained for 2 to 5 years? (Is it a newer generation of subQ?) Furthermore, is subQ not suitable for everyone but it is for patients with deep nasolabial fold? In addition, some people on the Internet mentioned that after hyaluronic acid injection, there will be protrusions when touching the application site for a long time (forever?)?

A: How long will hyaluronic acid last is related to particle of hyaluronic acid (the macromolecule-that is, subQ-can last a little longer), and it has a greater relationship with the site of application. Because it will move frequently on nasolabial fold, the effect will be shorter, probably in half a year.
Personal reaction to hyaluronic acid is also a factor. Some people have longer-lasting hyaluronic acid. In our clinic, hyaluronic acid will not be claimed for so long. If possible, use subQ to treat nasolabial fold. No protrusions will be touched.Hyaluronic acid is a temporary filler. Taiwan has also introduced a long-acting filler, which is a chemical material (called Aquamid). It has advantages and some risks. The doctor will analyze the pro and con of it in the consultation.

Q: After applying Botox, can the face be illuminated with X-rays? Will X-rays cause mutations in Botox?

A: Botox was originally an exotoxin secreted by bacteria. After toxin was absorbed by the nerve, the nerve cannot release acetylcholine (a nerve-conducting substance). As a result,muscle can not contract and muscles become thinner (these are local effects, not systemic effects). X-rays will not cause mutation of exotoxin.