Dissatisfaction with Fillers.

We  saw a patient today who has been treated elsewhere and  is displeased  with the firmness in the nasolabial fold region (the depression  from the  side of the nose to the corner of the mouth), and she did not feel  that  the area was adequately treated. We discussed the fact that some  patients’  soft tissue anatomy makes it difficult to fill that area  optimally to get a  fully smooth appearance, as it remains somewhat  tethered to the deeper  structures. Also, some patients have an overactive  muscle that raises the upper  lip and this contributes to the deepening of  the nasolabial fold. Most of the time,  when it occurs, the patients  benefit from filling of the cheek to help lift the skin away from the nasolabial fold and  therefore make the fold  more shallow, but we also occasionally have to  suggest a very small amount of Botox in the  muscles  that pull up the upper lip if the patient has an overactive  muscle in this  area.