What is the best option to lift my cheeks, nasal folds, under eye cut through and tighten my skin to reduce large pores?

Dr. Dean Kane Q & A Q. What is the best option to lift my cheeks, nasal folds, under eye cut through and tighten my skin to reduce large pores? I recently had three voils of Juvederm to my cheeks and lip line, and cut through with very subtle results. I want to see nasal fold lifted and also better a skin tone, possibly a laser treatment. Thank you. A. ​​Facial wrinkles are created from 4 different layers of the skin, fat and muscle. The top layer or stratum corneum of the epidermis is the rough, pigmented layer of the skin; creating most of the depth of the wrinkle. Exfoliation is best for this using

1. Microdermabrasion,
2. Retin-A (ZO Obagi Skin Health System), which also renews and regulates improved function of the deeper epidermis,
3. Some lasers and chemical peels.

The second layer is the dermis which thins with aging. The natural collagen, elastin and hyaluronic acid (which hydrate and toughen the skin) are thickened by the use of:

1. Fillers (Restylane and Juvederm), or
2. Retinoids (ZO Obagi Skin Health System), which also renews and regulates improved function of the deeper dermal skin cells.
3. Sculptra properly managed is the latest sensation in stimulating firming and thickening of the dermis

The next layer or fat also thins or droops with age and maybe:

1. Filled (Restylane and Juvederm), fat grafting or
2. Redraped (threadlift, short-scar, traditional, endoscopic face / neck / brow lifts)

Finally, the muscle which creases the skin into wrinkles and folds is weakened and rebalanced with:

1. ​Botox or similar injectable muscle relaxers like Dysport or Xeomin.

Based on your photos:

• ​ More projecting filler in the cheeks “apple” region will help volumize your mid-face and carry the nasolabial skin fold upward.
• ​I like the idea of a mid-face lift for you but consider that this is surgery and its pro’s and con’s.
• ​Retinoids are the best for skin texture, pores and pigment

​ ​Everyone needs one or more layered improvement and in personalized combinations to achieve their optimal result. ​ ​Consult with a very experienced, Board Certified Plastic Surgeon or ENT Face surgeon for your proper evaluation and best recommendations. All the best!