The parentheses around the mouth is one of the most common concerns addressed by dermal filler. Dermal filler was originally created for the creases around the mouth, also called nasolabialf folds, or NLF for short.
What is Smile Line Filler?
Fillers that are used today in the NLF are made of Hyaluronic Acid, a molecule occurring naturally in your body. Dermal fillers are made of lab made hyaluronic acid (or HA), and are used to provide hydration or volume to the area they are injected in.
Dermal filler can be used to add volume and hydration to the NLF.
How Does Smile Line Filler Work?
HA filler is injected, or placed in the tissue by use of a needle or cannula. HA filler is a gel-like substance that draws water to it. We call filler that draws water to it 'hydrophilic.' There are different types of HA fillers brands. The most common HA fillers are Juvéderm, and Restylane family fillers. Think of Juvederm and Restylane as a last name. Juvederm fillers include Juvederm Voluma, Juvederm Vollure, Juvederm Volbella, Juvederm Ultra XC, and Juvederm Ultra Plus XC. Restylane fillers include Restylane Refyne, Restylane Defyne, Restylane Lyft, Restylane Silk, Restylane-L, and Restylane Kysse.
The fillers have different consistencies. Consistency of filler is measured by viscosity, elasticity, and cohesivity. The more firm the filler is, the greater the viscosity. The higher the G' (G prime), the less elasticity, or greater the stiffness it has. They also have different amount of hyaluronic acid and cross linking. The greater HA content, the more hydrophilic, and the greater the cross linking, the longer it can last.
Once the filler is placed, the tissue will need to heal. The filler will integrate with the tissue more and more over time. Our body breaks down hyaluronic acid the same way it breaks down our natural hyaluronic acid.
What Are The Risks of Smile Line Filler?
Injection Site Reactions
The most common risks are injection site reactions such as bruising and swelling. Around the mouth is a likely area to bruise and swelling is expected. Bruising happens when a blood vessel is punctured, which happens with a needle. A cannula can decrease this risk. A cannula is a blunt, flexible tube that travels through the tissue. The blunt end decreases the risk of puncturing vessels, though the risk is still possible. Swelling is also decreased with a cannula.
The three major adverse events with dermal filler are infection, rejection, and occlusion.
Infection
When we get a needle poke or scratch of any kind, this creates an opening to our body that has the potential for infection. The provider should clean the injection site with an appropriate antiseptic before injecting. Do not wear makeup for 24 hours treatment and keep the area clean to decrease the risk of infection.
Rejection
This is an incredibly rare risk where our bodies can identify the filler as a foreign body and attack it with our immune system. This looks like inflammation and nodule formation an average of eight weeks after treatment. It is not something minor, and truly is a reaction. The severity may vary. This is every so slightly more likely with the presence of an autoimmune disease, where the autoimmune system is already hyperactive. This can also happen after or during an intense illness.
Occlusion
This is the scariest risk with filler anywhere in the face. This is also a very rare risk. There are arteries, or large blood vessels in the face. In the smile lines there is the facial artery. If filler is injected into an artery and the artery becomes blocked from flow, the tissue that relies on the artery for blood and oxygen can die. This may result in a scab or a scar if not treated immediately. This looks like severe, throbbing pain after the injection, along with visible blanching or a stark white appearance of the tissue. It usually occurs immediately upon injection.
A properly trained practitioner is constantly assessing for this risk while injecting. This risk can happen to any provider, no matter how long they have been injecting, but is detrimental in the hands of an untrained practitioner. Once identified, the filler reversal agent will be injected, and the occlusion will be reversed. Reversing an occlusion can be difficult. The sooner the occlusion is reversed, the skin will have less damage.
Symptoms of a vascular occlusion include severe pain, blanching, mottling of the skin, and blistering. The longer the tissue is unable to get blood and oxygen, the tissue will begin to die. A cannula decreases the risk of occlusion by being less likely to puncture blood vessels. It is still possible to occlude an artery with a cannula.
How Much Does Smile Line Filler Cost?
The price of the filler depends on a lot of factors. These factors include the volume of fillers injected by the practice, the demand of the injector, the license, the location, and the type of practice. NLF fillers cost anywhere from $450-$800+. Anything under $450 as a standard price is very suspicious. Pharmaceutical companies may run promotions with a practice, where they get access to different discounts. If this is the case and the product is verified by the pharmaceutical company, you will be enrolled in a rewards program by the pharmaceutical company.
What Should I Do Before My Smile Line Filler Appointment (Pre Care)?
Avoiding blood thinners to prevent the risk of bruising is a good idea. Common blood thinners are alcohol, aspirin (and NSAIDs), fish oil, gingko biloba, ginseng, and garlic. If you are on a prescription blood thinner, it is possible to have injections as long as your primary care gives the okay and you are not in critical health.
Do take supplements like Bromelain and Arnica to help decrease your risk of bruising and severity of swelling. You can take them for three days to a week prior to the appointment and continue to take them while healing.
If you have high anxiety or are really nervous, you may have a history of fainting with injectables, like getting needle pokes or giving blood. This is called vasovagal syncope. To avoid fainting, make sure you have eaten before the appointment, avoid coffee, and be hydrated. Communicate your fainting history to your provider. It helps to talk during the treatment, or be distracted. To avoid fainting, make sure you do not hold your breath. Relax your upper body. If you feel yourself about to faint, squeeze your abdominal muscles, and tell your provider so they can lay you down.
If you love to workout, plan your workout before your appointment. Working out is discouraged for a few days after filler.
What Are Smile Line Filler Appointments Like?
First your provider will assess your concerns and expectations. They will assess your face and check your medical history. You should disclose any medical conditions, allergies, medications, and current pregnancy or breastfeeding information. The only people who should not get filler are those who are pregnant, breastfeeding, severely or acutely ill.
They should take baseline pictures in consistent lighting of your treatment area to store in your chart. They should educate you on the risks of the procedure. They should assess the characteristics of your facial features.
You will likely have numbing cream on for at least 30 minutes if you arrive on time and check in promptly. I have heard of some clinics that do not numb.
Your smile line area will be cleaned and prepped, and they will inject the product with a series of injections with a needle, or two injection sites with a cannula. It will take about 10-25 minutes. You will bleed from the pokes. You will still feel the needle pokes even if fully numb.
What Should I Do After My Smile Line Filler Treatment?
Do not wear makeup for 24 hours. Do not work out for the first few days because it can make your lips swell. Avoid blood thinners for the day after your treatment. Do take healing supplements like arnica and bromelain to help facilitate healing. Do gently massage your lips if you feel bumps a few days after treatment. Not all providers want their patients to massage their lips. Do apply ice to help the swelling and pain. Do sleep sitting upright if you would like to decrease your swelling. Do schedule a follow up after two weeks if they are not satisfactory.
What Does Lip Filler Feel Like In The Smile Lines?
Nobody ever told me this, but the first time you get lip filler, it will feel like there is something in the tissue for the first two weeks to month. After the first month, that firm feeling goes away as the filler softens. Once fully healed, the tissue feel soft, flexible, and near identical to what it felt before getting filler.
What To Expect From Smile Line Filler
If you express your goals and expectations to your provider, your provider should be able to educate you on if those goals and expectations are realistic or not, and what they recommend.
In the first few days after filler, it is normal for the tissue to feel slightly bumpy. This is due to swelling. Sometimes filler bumps do not fully resolve on their own and need to be touched up either by massage or by placing a small drop of Hyaluronidase, the reversal agent for filler. This does not take away from the treatment outcome, only the bump.
If you like your result immediately after injection or in the first few days after treatment, you will likely desire more filler. One syringe of filler does not always change the NLF depth, but can provide a hydrated plump effect that is very subtle. One syringe looks different for every patient. You may not get the same result or have the experience that a friend of yours had. Bodies are very different, and smile lines are very different.
If your result is still too minimal after one syringe, you can get a second syringe two weeks after your original treatment if they are fully healed. Many patients can get two syringes (one syringe per side) in one appointment. You can continue to layer filler. The more you layer, the longer it will last. Most hyaluronic acid filler lasts more or less about a year. We break down the filler over time, and may feel like our lips do not have any filler three months or so after treatment. This only means you need more filler.
Which Type of Filler Should I Choose For My Smile Lines?
It is best to defer to the injector to choose your lip product. When I inject patients, I get a feel for the look and outcome the patient is expecting. Here is a small bit of information to help you get an idea of what filler type you may want.
Juvederm, Vollure, or Defyne are common options for smile lines. Juvederm is the most plump, though one syringe of Juvéderm and one syringe of Restylane Defyne provide fairly similar results. You will likely need multiple syringes over time. If you want a visible difference in your smile lines but don't want to have that much change, one syringe of Juvederm or Defyne is also a great choice. If you want a hydrated effect for a fine line, but not a volume difference, Restylane Refyne, Kysse, Silk, or Volbella is the choice for you.
When I assess patients, there are so many factors I take into consideration before deciding on product choice. Most of them are based on what I see on the patient's face and their goals. Keep in mind, politics play a great role on which product providers pick.
Am I A Good Candidate for Smile Line Filler?
You are not a candidate if you pregnant or breastfeeding, expect a perfect result, or do not accept the risks that come with the injection. Filler is a medical device that is bound to the rules of science. It does not work like makeup. It is also very possible to not see significant results. It is not realistic or natural to fully eradicate the smile line fold. It is necessary to have smile line to look proportionate. If you are not okay with this, you are not a good candidate.
A good candidate is someone who is looking to minimally soften the smile lines. They understand and consent the risks of the injection. They understand they may or may not see significant results with 1-2 syringes. They do not expect absolute perfection without a touch up. They are able to be local to the clinic two weeks later in case they need a touch up.
If you live in Southern California, specifically Los Angeles, Orange County, or San Diego, schedule to see Jasmin in Costa Mesa, California for Smile Line or Nasolabial Fold Filler. Consultations are free.
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