May 9, 2008 (San Diego) -- Next to Botox, the most popular nonsurgical way to freshen up your looks is with a so-called "soft tissue" filler, often relied on to smooth the nose-to-mouth line called the nasolabial or nasal labial fold.

As more of these fillers have become available and demand has soared, physicians who inject them have learned more about how to use them effectively to wipe away the years, say physicians speaking at the annual meeting of The American Society for Aesthetic Plastic Surgery in San Diego.

Among the popular fillers are those with hyaluronic acid, such as Restylane, Juvederm, Perlane, and Elevess; and those that are synthetic, such as Artefill, Radiesse, and Sculptra. Typical costs are $500 and above per syringe, with more definitive folds needing more filler.

The Goal: Don't Obliterate It

The goal of using the fillers should be not to "obliterate" the line but to restore it to how it used to look, says H. Steve Byrd, MD, a Dallas plastic surgeon and clinical professor of plastic surgery at the University of Texas Southwestern Medical Center at Dallas. Byrd spoke on a panel about effective management of the nasolabial fold.

"I like patients to bring in photos of themselves 10 or 20 years ago," he says, and he uses the photographs as a guide.

Nasal Labial Crease vs. Nasolabial Fold

It's important to distinguish between a nasolabial crease versus a fold, says Miles H. Graivier, MD, an Atlanta plastic surgeon who also spoke on the topic.

When gravity sets in further, the crease can develop into a fold, where the skin droops down over the crease, he says.

For moderate to less severe folds, one of the dermal fillers may be enough, he says. But for deep folds, just injecting filler may not solve the problem, he says.

For these, he uses an incision-less dissection device that includes a needle and wire; when inserted, it releases the deep lines by separating them from the underlying tissues. Then a filler can be injected more easily, if it's still needed, says Graivier, who serves on the medical advisory panel for the device's manufacturer.