Should you treat cheeks or nasolabial folds with dermal filler?
Are you chasing nasolabial folds? For inexperienced and newly trained aesthetic clinicians, it can seem like the obvious target when they are so clearly visible on many patients – you just want to fill them – but could you risk your patients looking ‘odd’ if you do not address their lost cheek volume.
And what about men? They do not want full, luscious cheeks like a woman. So, is there still a place for treating the nasolabial folds (NLFs) or are they redundant in favour of cheek augmentation?
In this blog, Dr Tim Pearce discusses how to decide if it is appropriate to always treat the cheeks if your patient complains about their NLFs, alongside the different approaches needed for restoring the male face compared to the female face, especially in relation to avoiding feminising men by using incorrect techniques when treating their cheeks.
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Should you always restore the cheek when you are attempting to treat the nasolabial fold?
The short answer is no, says Dr Tim. It is, however, a common solution for female patients because ageing in women usually involves lateral volume loss, with the fat pad getting relatively smaller in size laterally, more so than medially, causing the cheek to slump forward to create the nasolabial folds. By restoring the volume loss, you can achieve a lift that corrects the NLFs.
The male anatomy and aesthetic are different. Men tend to have less fat in the upper cheek bone area and less fat in the medial cheek around the nose, all of which are more feminine characteristics for a fuller cheek. The formation of a nasolabial fold in men is therefore more akin to a genuine wrinkle or a fold rather than due to the decent of the fat pad above. Therefore, as a rule, men do not require support from above or volume restoration in the cheek. When treating male patients, the focus is on the anterior cheek and the NLF itself
How to treat the male nasolabial fold without feminising the cheek
The aim is to cautiously replace volume, to achieve a lift in the tissue, but without augmentation with men, as this will feminise.
Dr Tim’s tip is to ask your male patients to smile. On doing so, you will often notice a small indentation where the anterior part of the cheek meets the lateral part. This area becomes a target for harmonisation with small volume deposition of your dermal filler product, in a way that will not result in full, rounded (feminine) cheeks, but will provide some support from above to address the NLF. Additionally, you can then move to looking for gaps in the fat pads, such as a shadow from the zygomatic ligament that could benefit from a little volume. Dr Tim notes that the junction between the zygomatic ligament and the superior part of the cheek can be projected anteriorly and often provides support for the NLF (CK3 if you use the Allergan MD Codes protocol). Careful volumisation in these areas can reduce the need for direct treatment or much treatment of the NLF itself in men.
The key is to be gentler with your volumising technique in men, approaching more anteriorly, rather than laterally as you would in a woman, and with small volume. Be sure to explain your treatment plan during your consultation so you can reassure your male patients that you will not be feminising their face with this treatment. Explain that you will be providing just enough volume to give a small lift to the nasolabial fold area, whilst focusing on maintained the chiselled angles, and strong cheek and jaw lines associated with athletic male beauty. It is important to preserve the jawline dominance in a man, so augmenting cheeks (as you would for a female) will upset the balance.
When restoring a face, either male or female, the goal is not to add volume everywhere; men will be better looking if you maintain defined angles with a few little imperfections and shadows where you can see the bone structure underneath – achieving a more masculine and desirable look.
How to explain that you need to treat the cheek and not the nasolabial fold in a female patient
The symptom may be the nasolabial fold, and that may be the reason that the patient picked up the telephone to book the appointment, but the cause and solution may lie in treating the cheek to restore volume, especially in female patients. However, this can present a problem with cost. Restoring cheek volume will inherently require more dermal filler product to achieve the best aesthetic result, but the patient is adamant that they only need the quantity of product needed to ‘fill’ their NLFs. As a clinician, what do you do?
The solution lies in your consultation, says Dr Tim, and how good you are at educating your patients about the changes in their face and the treatment options available to counter those changes. He explains that the non-verbal cues from your patients can be a useful tool. For example, a patient may verbally tell you that they are bothered by their NLFs, whilst at the same time placing their hands on their cheeks and moving them upwards to stretch out and remove the visible fold. You can use this movement to explain to them that they have already understood the physiology and involvement of the cheek in the creation of the NLFs, and therefore your treatment plan revolves around revolumising the cheeks to lift the NLFs.
Listening to your patients, observing how they explain their concerns means that you can react in a more educational fashion which stops your advice from sounding like a sales pitch or an attempt to bump up the cost to them.
Do you need to treat both the cheeks and the nasolabial folds in some patients?
If the presenting complaint from a patient is the nasolabial fold, Dr Tim explains that it would be rare for him not to address the nasolabial area as well as treating the cheek. He favours a push and a pull approach with a 70-30 split between cheek and nasolabial treatment. A little volume in the nasolabial plus support in the lateral cheek.
What are your thoughts on treating NLFs? Do struggle to treat male patients, would you like more male patient-centric training and videos to be available? Why not drop Dr Tim a comment or question on social media, you can find Dr Tim Pearce on Instagram.
Aesthetics Mastery Show
Cheeks Vs Nasolabial Folds. Is It True That Cheeks Make NLFs Redundant?
For more information, watch the Aesthetics Mastery Show where Dr Tim Pearce talks about discusses whether or not we should treat cheeks if the patient complains about their nasolabial folds; how to decide when it’s appropriate; and the difference between men and women when tackling these areas..
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