Facial Balance First: Rethinking Nasolabial Fold Injections

Dr Litani stressed the importance of understanding how the face ages and looking at the face as a whole rather than individual cosmetic subunits during her presentation, “Stop Injecting the Nasolabial Folds (at Least During the First Visit)! Facial Balance First!” at Dermatology Week 2023. She highlighted the significance of facial balancing for a natural refreshing effect and emphasized that “filler placement should not focus on filling in lines.”

Caarin Litani, MD, is a board-certified dermatologist and fellowship-trained Mohs surgeon. She is a partner in Dermatology Partners, a medical, surgical, and cosmetic dermatology practice in Wellesley, MA.

Dr Litani explained that “aging happens to everyone and is caused by the loss of collagen, elasticity, fat, and bone, as well as gravity's effect on the face.” She also listed other factors such as dynamic lines, sun damage, and seborrheic keratosis. Dr Litani outlined various treatments, including healthy lifestyle, skin care, injectables, laser, energy devices, microneedling, and chemical peels. Among them, she particularly discussed fillers, which “can be used for facial balancing, refreshing, enhancing, and redraping.”

Facial balancing involves maintaining the youthful, upside-down egg shape of the face, which includes fuller temples, high cheekbones, narrow jowls, strong jawline, and a well-demarcated chin. Dr Litani stressed that “only surgery can truly lift, but facial balancing can create an illusion of a lift by improving emotional presentation and changing light reflex patterns.” She also advised addressing finishes after achieving structural support, such as temples, nasolabial folds, lips, melolabial folds, and tear troughs.

Dr Litani recommended “starting from the top by providing structural support to the cheeks and lateral jawline first before addressing the chin complex.” Limitations include eye bags/fat herniation, which should avoid fillers and require lower blepharoplasty, and heavy jowls/turkey neck that need a lower facelift instead of fillers.

Finally, Dr Litani suggested “taking time with facial assessment and taking multiple pictures at different angles and studying them, as well as the patient, head on.” She also advised “showing the patient their photos at different angles” and explaining how “addressing the face as a whole would keep them looking like themselves with a more youthful balance.”

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Reference
Litani C. Stop injecting the nasolabial folds (at least during the first visit)! Facial balance first! Presented at: Dermatology Week; May 3–6; Virtual.