How to fill nasolabial folds and avoid arterial injection of filler

Article medically reviewed by Dr. Gavin Chan

Templestowe Lower, Berwick and Beaumaris Clinics

Dr. Gavin Chan, MBBS, General Registration (MED0001175745), founder of the Victorian Cosmetic Institute, began offering cosmetic medical treatments in 2004. Formerly a trainer for cosmetic pharmaceutical companies, Dr. Chan currently concentrates on offering ongoing training to cosmetic doctors at the Victorian Cosmetic Institute. He ensures that all doctors stay updated with the latest procedures and methods in the cosmetic industry. Read More

Did you know that your smile is one of the loveliest parts of your face? The more time you spend smiling and laughing, the better life is. But a combination of the natural ageing process and your years of laughing and smiling can create nasolabial folds. Also known as ‘smile lines’ or ‘laughter lines’, nasolabial folds start at the bottom of your nose and extend to the outer corners of your mouth. These indented lines become more prominent when people smile and can deepen with age. When our patients look in the mirror and see visible nasolabial folds, they often regard them as a sign that they’re ageing. Understandably, they book a consultation with a Cosmetic Doctor or Cosmetic Nurse with the aim of ‘getting rid of them’ by using dermal filler treatment.

Since 2005 Dr Gavin Chan (MBBS, Cosmetic Doctor, Liposuctionist) and his team of Cosmetic Doctors and Cosmetic Nurses have been treating patients who have concerns about their nasolabial folds. Treating nasolabial folds with dermal filler has significant risks that many people aren’t aware about. Dr Gavin Chan and his highly trained and experienced team, unlike many clinics, aren’t keen on using dermal fillers to treat nasolabial folds anymore. Dr Gavin Chan’s extensive training, experience and aesthetic eye for detail, have resulted in a way to treat nasolabial folds with dermal filler.

What causes nasolabial folds and why are they such an issue for people?

Nasolabial folds are a natural part of your face that lie as a gradient between your cheeks and upper lip. Your nasolabial folds are composed of dense bundles of fibrous muscle and tissue and tend to become more prominent with age. As your skin becomes thinner and succumbs to the effects of gravity, you may notice them more. Nasolabial folds become more prominent and obvious due to factors including:

• Sun exposure which can prematurely age and damage your skin and create changes in skin texture
• A natural loss of collagen due to the natural ageing process, resulting in your skin becoming thinner and weaker
• A loss of facial fat leading to your cheeks, nasolabial folds and marionette lines appearing saggy
• Smoking and exposure to environmental pollutants
• Frequent weight fluctuations or rapid weight loss

Dr Gavin Chan explains that nasolabial folds becoming more prominent, “is a natural part of the ageing process where your cheeks descend down and in to fold over your upper lip area”. When he first started practicing Cosmetic Medicine, most of his patients were concerned about their nasolabial folds and wanted them treated with dermal fillers. Dr Gavin Chan notes that since we only see ourselves in two dimensions in a mirror or in a photo, we have a ‘warped sense’ of what we look like. Since we can’t view our three-dimensional image and see our facial shape and contour, we only focus on the folds, wrinkles and lines. Your nasolabial folds are one of the major folds in your face and because they’re in the central part of the face, it’s natural that your attention is drawn to them.

Why nasolabial folds are one of the most dangerous areas to fill in your face

When you make a booking for dermal filler treatment, you’re probably unaware of any dangers that may be involved. At your consultation, our highly trained and experienced Cosmetic Doctors and Cosmetic Nurses will highlight all the risks so you can always make an informed decision. A major danger zone for dermal filler treatments is at the nasolabial fold, where the facial artery runs right up to it from the jawline and past the corner of the mouth through nasolabial fold. When dermal filler is injected into an artery, it is potentially disastrous.

Whenever dermal filler is used near your nasolabial folds, Dr Gavin Chan notes, “We’re in facial artery territory. With so many variations in facial artery anatomy it can be very hard to know where the artery or its branches are. If dermal fillers are injected into the artery or its branches, it can potentially obstruct oxygenated blood supply to the skin or even travel further up to the blood supply of the retina of the eye and cause blindness”. This is why Dr Gavin Chan and his team of Cosmetic Doctors and Cosmetic Nurses believe the nasolabial folds are one of the most dangerous areas of the face to treat with dermal filler.

The standard way to inject dermal filler in the nasolabial folds is to use tiny 30 gauge needles. This injecting technique involves using a short, sharp needle to inject multiple spots along the nasolabial folds using boluses, otherwise known as big blobs of filler. Unfortunately this widely taught and used injection technique provides multiple opportunities for the needles to enter into an arterial system where facial artery occlusion can occur.

It’s important to note that the diameter of arteries in this area of the face is tiny and it only takes a small amount of filler to fill up the arteries and cause an occlusion, which could run further up the face towards your eye.

Get the best nasolabial folds treatment in Melbourne

Our patients have dermal filler treatment with our highly trained and experienced Cosmetic Doctors and Cosmetic Nurses to address their nasolabial folds, forehead wrinkles, crow’s feet and upper lip lines. We’ve changed our approach to treating nasolabial folds with dermal filler treatment because of the high risk involved. If we do use dermal filler treatment on our patient’s nasolabial folds we take several very important precautions to minimize any risks that may occur.

Firstly, we only use blunt tipped cannulas to inject perpendicular to the artery direction. A cannula is a blunt tipped instrument like a needle but has a rounded blunt tip. This means there’s less likelihood of the wall of the artery being penetrated with dermal filler. While we’re highly trained in facial anatomy, we also understand that every patient is different. We take the precaution of injecting perpendicular to your artery since it’s a lot harder for the dermal filler to enter it via this injection technique.

Secondly, we only inject dermal filler using blunt tipped cannulas by using a very, very slow injection method in any areas where there’s potential for intra-arterial injection. This precaution means that if you’re unfortunate enough to get dermal filler in an artery, you’ll experience pain and the Cosmetic Doctor or Cosmetic Nurse can immediately stop injecting. By injecting slowly your Cosmetic Doctor or Cosmetic Nurse will be able to see immediately if there’s any blanching or whitening of a skin as the blood supply drops off. They’ll be able to immediately withdraw and stop your injections before matters get worse and the filler has traversed right up the arterial system.

Thirdly, we always have an emergency back up plan in all our treatment rooms. If dermal filler is injected into an artery and the signs of vascular occlusion become apparent, we have a reversal agent at hand to inject into that area immediately. Using hyaluronidase dermal fillers can be quickly reversed and broken down.

Since 2005, we have successfully treated thousands of people’s nasolabial folds to help them look and feel younger. Led by Dr Gavin Chan, our highly trained and experienced Cosmetic Doctors and Cosmetic Nurses are very aware of the risks of treating nasolabial folds with dermal filler treatment. We are committed to treating all our patients with the utmost care and professionalism and always have dermal filler reversal agent on hand. Book your nasolabial fold consultation or call our friendly and helpful customer service team on 1300 863 824.