Juvederm Ultra Injection to NasoLabial Folds (laugh lines) by Reston Virginia Cosmetic Surgeon

[etamlous]

Is there a reason you don't use Artefill for laugh lines if it's considered most long lasting and "permanent" compared to all other fillers that last between 6 months to 2 years at most?

[DrNaderi]

@etamlous Good question. I used to use Artefill and I was one of the very first cosmetic surgeons in Northern Virginia to start using it but I prefer safer fillers like Juvederm, Restylane and Perlane. They have a lower risk of infection, lower risk of lumps and nodules and if a complication occurs, they are more treatable. I have seen patients from Europe who have had permanent fillers with permanent complications and problems and I want my patients to avoid problems.

[swagbucksgirl]

hello dr, will profraxil laser help at all around the laugh line area before i do juvaderm?

[DrNaderi]

@swagbucksgirl

Lasers do help with lines and skin elasticity but for most people fractionated lasers are too weak to do much for their laugh lines. Fillers like Juvederm give the area more of a lift by adding volume. But lasers can be used before or after the injections as long as you wait a few weeks in between the filler injection and the laser treatment.

[thiemogamma]

Dr Naderi, how do you treat bags under the eyes? Do you use fillers for that?

[DrNaderi]

@thiemogamma Depends on the bag. If the lower eyelid bags are just extra fat then they have to be removed but if the bags "look like" bags because the area underneath called the tear trough is hollow then filling the tear troughs with Restylane can minimize the appearance of the bags. Each patient's lower eyelid bags are unique.

[randomtube26]

what age would be appropraite to have it done?

[DrNaderi]

@randomtube26

The most common age group for fillers to the laugh lines is in the 40's-60's but there are some patients who are in their 30's and need it and I have some 80 year old patients who want to look good and come in for fillers to their smile lines as well.

[babymandrake]

Hi Dr. Naderi, could you recommend any lotion or activities that can help reduce smile lines? I'm 25 and I'm starting to notice the groove is getting deeper.. also I smile a lot which is why. I've been thinking about getting fillers but I'm not sure if I should do that at the current age. I read something about reducing cheek fat by exercising.. would that work?

[DrNaderi]

@babymandrake

Sleeping on your face and smiling give you smile lines. Some gorgeous young women with very full cheek bones will have smile lines and its not a big deal. Enjoy your life. Dont worry too much about the nasolabial folds. Use a good moisturizer to prevent the skin from cracking and think about Restylane once or twice a year but be careful.

[Minx821]

Hello

Interesting I found this.

I am from Perth, Western Australia.

I had Juverderm injections in my naso labial folds last week. I am very disappointed with the result, I see very little difference. Cost me $AU400.00. She used I think 3/4 but said we may need to top up in a few weeks and that will cost me another $200AUS. Im unsure. I feel like I already wasted $400 and dont really want to waste a further $200 unless I get a smooth result. Unsure....

[DrNaderi]

@Minx821

Without seeing you and seeing your before and after pictures it is hard to judge the results. I will tell you that "full correction" is important. For example, if you needed 2 or 3 syringes of a filler but only did 1 syringe then you may be very disappointed. Injection technique is also very important. Finally your expectations are also important. Some patients expect the lines to be totally gone and that is often unrealistic but in your case it sounds like not enough was used.

[heyylauri]

sigh.... i already have deep laugh lines and i'm only 15...

[DrNaderi]

@heyylauri

Don't worry. Your laugh lines are normal. I bet you have full cheeks and young people with nice full cheeks will have normal laugh lines. Its only in older people that get wrinkles there and not just a fold that we do injections. At 15 you need to enjoy your life and pursue education and sports and music and fun and not worry about smile lines.

[DrNaderi]

@OanaIenciu

Hi. Im not sure what you mean but I am guessing you are asking if you have to do the juvederm injections only one time or you have to repeat the injections? You do have to repeat the injections about twice per year to maintain the results. They are not permanent fillers.

[laserawaywpg]

interesting video.

[wall1]

do you recommend anyone in ny

[DrNaderi]

@wall1

There are plenty of top doctors in NYC. You can visit the AAFPRS website and see who is close to you and then look at their credentials and their results.

[wall1]

is this juvederm done for dark circles too

[DrNaderi]

@wall1

If dark circles under your eyes are caused by tear trough depressions or hollows then juvederm may be an option although I prefer Restylane for that area most of the time.

[RodTalon0000]

I wish they had a natural filler... i just dont want unnatural chemicals in my skin... it messes with your skin in the long run

[DrNaderi]

@RodTalon0000

Juvederm and Restylane and Perlane are as natural as it gets! These are Hyaluronic Acid molecules which normally are found in your body and skin. Nothing "unnatural" about it at all. But no filler is 100% safe and if it makes you nervous then simply don't do it but please do not make false statements like "it messes with your skin in the long run" without the proper facts or studies or training to back it up. Your statement is simply not true if the procedure is done well.

[sqlara]

Hi doc I am 35yrs and have massive deep folds along with turkey neck! I am too young to have them I think. What procedures should I do or can u recommend?

[DrNaderi]

@sqlara

Hi. I cannot make specific recommendations without seeing and examining you. Please see several good ethical Board certified facial plastic or plastic surgeons and then decide with care. Good luck.

[townes8714]

Interesting video, thanks for posting. I have an artery roughly an inch away from the corner of my mouth that is close to the surface of the skin. It protrudes and I can see it pulsate, it has gotten worse over time. Could Juverderm help with this? I think it is because of the loss of fat over time.

[DrNaderi]

@townes8714

You can fill around it or you can see if laser treatments can be done to coagulate it or surgically remove the vessel. I cannot tell you what to do without seeing and examining you.

[FreeBlago1]

I am 25, but I look 15. I want to do the opposite so I look more age appropriate. I want to add some nasolabial folds. How can I do this?

[DrNaderi]

@FreeBlago1

enjoy your youthful look and dont mess with your face.

[threeoneg77]

I had this procedure done, and it didn't work. The injected material went above the folds and did not improve their appearance at all. The plastic surgeon who did the injections is a very highly respected surgeon in Southern California and one the most expensive..I didn't cut any corners with the procedure. Can anyone answer why this didn't work for me? If I saw this doctor would I get better results?

[DrNaderi]

@threeoneg77

Being "highly respected" or famous does not guarantee great results. Micheal Jackson's Plastic Surgeon was a VERY famous and respected older Plastic Surgeon in LA.  If the injection was placed too laterally or too high then the folds can look even worse.

[threeoneg77]

@DrNaderi So is there any way to guarantee good results or is it pretty much a gamble every time? It's like "give me $2,000 and I m i g h t be able to make you look better. Oh and no refunds."

[DrNaderi]

@threeoneg77

It should not be a gamble at all. Too many people take chances with their faces. Once you do your homework and find a very good Facial Plastic Surgeon then the rest is a small chance you take and a small risk you have to accept but if you just walk into any spa or choose a family doctor who has been doing injections for a few months then you are taking a much bigger gamble and chance.

[threeoneg77]

@DrNaderi I guess I'm just upset because I spent so much money and didn't get any results. The doctor is in Newport Beach, CA in Orange County in some VERY expensive real estate, a medical building that I'm sure has rent that is like $5,000/mo or something..this is right next to Corona Del Mar some of the richest people in the world live there. He was not a young surgeon, he was in his 50's, he had been practicing for over 20 years. I hope the next time I try this procedure it actually works.

[DrNaderi]

@threeoneg77

Im sure his rent is 2x or 3x that but that has nothing to do with how good a doctor he is nor has it got anything to do with what kind of results you received or did not receive. Make sure you find a good skilled and ethical doctor who will talk to you and diagnose the problem rather than just take your money and put some filler anywhere. Good luck.

[SomethingNormal00]

i want this when i get older

[ThePrisonBreakFan]

i want my lips done but i am scared of needles. does anyone know if its painful, plus what if they inject it in the wrong place?

[DrNaderi]

@ThePrisonBreakFan

Lip injections can be made much more comfortable with a dental block to numb the lips first. Many patients get lip augmentation using fillers without a dental block since Restylane and Juvederm have lidocaine in them these days. The technique of the doctor injecting is very important. The better the technique, the less the pain, less swelling and less bruising. Find an experienced plastic surgeon to make sure its not injected in the wrong place! 

[russiuka38]

cost that much to last only 4 to 18(not clear) month, better to save for plastic segery instead. Looks very painful when nidle goes again in the same area, which is bleading...

[DrNaderi]

@russiuka38

First of all its not that painful. I have never had a single patient ask me to stop because the pain was too much. But much more importantly, there is no "Plastic Surgery" to correct the smile lines in a young patient like this. Facelift do not correct the smile lines and she does not even need a facelift. Therefore she does not need surgery no matter what the cost. And even surgery results do not last forever. Injection of fat or fillers are the most common approach to this

[madiha610]

hi, how much does it typically cost. just an estimate, thanks

[DrNaderi]

@madiha610

Hi. It just depends on the filler you need and the volume you require. For example one syringe of Restylane may be $600. If you require more volume then you pay for additional syringes. Some times doctors may discount the 2nd or 3rd syringe so you can get the volume you require without hesitating too much about the price. Other fillers have different prices. The cost of the syringe is one consideration but the skill of the doctor injecting you is more important.

[madiha610]

@DrNaderi thanks for the quick reply and thorough information. i'll keep it in mind.

[KrissyKful]

I had one syringe each of Restylane for the naso folds, they werent too deep but my cheek area has lost alot of volume so it makes my face look flat. I can still see the naso fold lines and wondering if I should have used two syringes for each side instead of the one? Or perhaps it was the injector, shes a certified nurse and has done injectons for more than 7 yrs. and im also wondering if I should try Perlane instead? your work looks awesome, wish you werent so far away!!!

[DrNaderi]

@KrissyKful

Thank you. Completely getting rid of the nasolabial folds is unrealistic and if over injected it can make the face look puffy and snout-like. I love injecting the midface and cheek area to give it fullness and volume which are signs of youth and beauty. I cannot tell you what is best for you since I have not seen or examined you. See a few doctors and get a few different perspectives. Always stay with "safer" Hyaluronic acids for your first time (Perlane, Restylane, Juvederm)

[chezwickgee]

you mention that the kind of product to choose should depend on the type and severity of the lines. I have very deep naso folds that I have had all my life, of course with age they are very deep. Not at all like the model in the video. Is there a product that is better for deeper lines?

[DrNaderi]

@chezwickgee

I prefer Perlane or Radiesse for very deep nasolabial folds. However, I have seen plenty of patients who barely have any lines who think they have very deep lines. I try to talk these patients out of fillers or recommended a very conservative amount of juvederm ultra xc. It just depends. It also depends on the state of the cheeks and midface. If all of the cheek fat pad has dropped down creating deep nasolabial folds then that should be addressed first.

[chezwickgee]

@DrNaderi you are very kind to reply so quickly and thoroughly. I am just beginning to explore this idea. I know what you mean about perception. But I have been told about my lines since I was very young (I am 48). they are a genetic component of my face, and I have avoided any thoughts of change. In fact, I worry that they are so deep and actually creased, they might not respond to a filler, or worse look strange and puffy. I d like to opt for something extremely minor.thank you so much.

[Solayg]

Hi There,

I had restylane injections for Naso. Folds over 1 year ago and I still have bruising in the left side of the injection area not to dark of a bruise but it is still dark enough to have to use makeup to cover? The spa said sometimes that happens Is this Permenant? How do I fix it

[DrNaderi]

@Solayg

I highly doubt its a bruise. Bruises don't last this long. You could have had the injection too superficially creating whats known as a Tyndall Effect or you may have had tattooing of the area especially if they marked the injection areas first with a marker and then injected you. However, without seeing and examining you, I cannot tell you what it is or what the solution would be. You need to see a good local plastic surgeon and not just trust the spa's answer. Good luck.

[tllktc]

I am really impressed by your prompt reply and most of all your injection technique!

I also understand you have done thousands of injections to obtain your level of competency and experience.Have you come across any severe allergic skin reaction that leads to scarring? Is it frequent? Is it fast ? I mean does it come with rashes first or delayed?

It is still a major concern for patient who is thinking of undergoing fillers injection.

I know even lotion can leads to scarring if allergic set in

[DrNaderi]

@tllktc

Thank you. I have seen patients who had questionable fillers by other doctors from outside of the United States who ended up with serious infections and scarring. As long as a relatively safe filler is used by an experienced doctor then the risks are minimal - not zero but close to it. For example, the risk of allergic reaction to Restylane is anywhere from 1 in 3000 to 1 in 10000. The actual filler and the technique are important.

[tllktc]

How many cc for the 1st , 2nd and 3rd injections?

Do you give local?

Do you do skin allergic test?

[DrNaderi]

@tllktc

No allergy testing is necessary with the FDA approved products I use: Perlane, Juvederm, Restylane or Radiesse. Typically I do 1-2cc on the first injection and 1-2cc injections subsequently. Some patients only need 1cc and others need 4-6cc. Just depends on the patient. Most of the products have lidocaine in them and pain is very minimal.

[itfelldown]

I'm curious, after the effects of the injections wear off do the lines then look deeper because they had been filled in? In other words, does the filler (once gone) end up making deeper lines? Also, do you get the stiff "can't smile" look with this filler?

Thanks

[DrNaderi]

@itfelldown

Good question. Actually the injections stimulate your own collagen production so theoretically the area should look slightly more filled in that if you had never gotten an injection. But, at the same time, theoretically you will have aged so the lines may be deeper regardless. But the injections wont make the lines deeper if you stop. The "stiff, cant smile" look is a matter of volume and injection technique and should not occur in good hands.

[td241]

This is one of the better videos on Juvederm I've seen. I'm just starting to get some laugh lines and really don't think that they suit me at all. Also, on my right side, there is one very, very deep wrinkle that I have hated. When i was in my teens, it would come and go. Now it's there and won't go away.

Would Juvederm also fill out a small, very deep wrinkle that runs with my laugh lines? Also, does Juvederm (if used consistently) prevent more severe laugh lines from forming? Thank you.

[DrNaderi]

@td241

Thank you. The reason laugh lines form is trifold: Loss of skin elasticity, continual "folding" of the area by movement or pressure (laughing or sleeping on your face), as well as descent of the cheek pads. Juvederm and Restylane can help. The injection technique is VERY important. Bad injection can make the lines worse. There are various techniques for different types of lines.

[TheMinnesotaMom]

How long does Juvederm typically last? How much does it hurt to receive injections into the nasolabial folds?

[DrNaderi]

@TheMinnesotaMom

Typically it lasts 6 months or so. Most patients do this twice a year. Juvederm now comes in a mixture with Lidocaine (numbing solution) so its not that bad at all. Gentleness of injection technique is also important.

[beatrizemo]

I am 30 and my skin is pretty much like your model's. I was debating whether to go with radiesse or juvederm. After seeing your video I will go with juvederm. It looks like you only used 1 syringe, does your model also have botox and lip augmentation? what does she do about large pores?

[DrNaderi]

@beatrizemo

For skincare we start our patients on medical grade cosmeceuticals like Obagi, SkinMedica, NeoCutis or Image products. Retin-A is often a part of it. Microdermabrasion and light chemical peels help with skin texture, tone, color and pores.

We also start people on Botox or Dysport in their 20's-30's to PREVENT getting lines and wrinkles.

[DYLAN3264]

We all look at ourselves and pick out things we don't like...and if you need it go for it...fined a well known,educated ..doctor and those who do,nothing wrong with it!!!!! I do it and the best thing ever....its worth every penny...i have friends who disagree and i am doing it for me...NO ONE ELSE..

[maccyao]

with a face like hers why the hell did she feel the need to go through that??? People these days are crazy.. we r all goin to look old at some stage trying to avoid it is like shovelling snow when it's still snowing!

[DrNaderi]

Maybe so but what I think is "crazier" is how people use the internet to criticize others. There is nothing wrong with self improvement - internally and externally. As long as patients choose relatively safe procedures and do not over do it, there is nothing wrong with trying to look your best. Medicine has advanced greatly in the last 50 years. We prolong life with medications and surgeries. No reason not to slow down the appearance of aging - as long as its done safely and conservatively!

[Jamesastonn]

@maccyao I agree

[wenjia1012]

Hi doctor, I am 28 yrs and I am an Asian, though people say my face look 10 yrs younger (seriously, I dont have wrinkles or laughlines), yet I really wanna do a prevention, can I receive this kind of treatment?? Thank you! (please check my face picture by clicking my youtube id)

[LadyOlivia35]

Her skin already looks nice--it doesn't look prematurely wrinkled at all!

[DrNaderi]

She is on an aggressive skin care and anti-aging regimen and gets in-office chemical peels and microdermabrasion regularly to maintain her good skin.

[TracerPistol]

The camera audio is terribly annoying and unprofessional. Had to mute in order to view.

[DrNaderi]

Terribly sorry you had to endure the annoyance! Will try much harder next time and get a professional camera crew! lol

[sexanddiamonds]

Thanks for posting. How much does this cost? How long does it last for? Do you look worse if you no longer use it, as in is this supposed to be a lifetime commitment or is one time okay? I have heard a lot of good things about you from my model friends by the way!! Please answer all 3 questions.

[DrNaderi]

Thanks ;)

Cost range is $600-850 per syringe. Most people do 1-3 syringes. It should last 4-18 months but it depends on you and the filler. As long as you want the results then you have to keep doing it but its also OK if you do it only once for a special occasion or something.

:)

[chattanoogahasfun]

Love the video.

[jmd11185]

I'd like to see how it turned out after a few days because initially I think she looked worse then before.

[DrNaderi]

The redness right after an injection is like using a highlighter over an area. As the redness goes away, it looks great in less than 30 minutes. There are before and after pictures of her on the "liquid midface lift" video on my YouTube site.

[jmd11185]

wow thanks for the prompt response. I'm 24 and have developed the laugh lines in around the same spots she has them. Those don't bother me. However, I'm starting to develop lines on top of my mouth up towards my nose. Will this stuff help that?

[DrNaderi]

My pleasure. I try to reply to as many posts as quickly as possible between seeing patients. The answer to your question depends on the nature of the lines. It may or it may not.

[jmd11185]

I have severe sun damage that caused stretch marks on parts of my body such as biceps when I was still a teenager. Now my skin develops red lines where wrinkles are forming on a weekly basis. I'm very troubled by it and its very unnerving to feel my skin tear.

[DrNaderi]

Hi,

The fat or filler should be injected at the same time to prevent the skin from tethering back down again. Subcision can be done after fillers but its best to wait a while.

[Sim2500]

just wondering, for a subcision procedure on a depressed scar, would you inject the filler after or wait a week to do it?

also can subcision be done after fillers?

sorry if this is a bit off topic

[DrNaderi]

About 6 months or so. Every patient is different. Some longer and some shorter.

Artefill is a good product when used appropriately. The patient and the surgeon injecting have to be ideal because its irreversible!

[meowmeowkitty3]

how long does it last in those areas...Also, what is your opinion on artefill?

[DrNaderi]

I use various techniques and the perpendicular injection is a beautiful technique that works very nice and most often times better than the serial filling horizontal technique.

I am not worried about hitting vital structures because I know the anatomy of the area and the is no vital structure in the way.

Also as I enter, I fill, so the material pushes small capillaries out of the way and you get less bruising.

[meowmeowkitty3]

So far I haven't seen a doctor who does a perpendicular injection. Are you worried about hitting an artery, especially so close to the nose and bottom lip?