2 December 2019 onur
This is the area that patients often describe as “deep wrinkles on both sides of my mouth”. You can find images by typing “nasolabial fold” in Google’s search box.
In Latin, nasolabial means “from nose to lip”. The nasolabial fold is the anatomical transition line that extends from the edge of the nose to the edge of the mouth and separates the lip from the cheek.
As one gets older, it gets deeper and often joins with the “Marionette fold” that runs from the lower lip down to the chin. It is one of the characteristic features of aged faces, and when it gets deeper, it may become an eye-catcher even for the most self-confident individuals.
If you are bothered by a prominent nasolabial fold, this article is for you.
The nasolabial fold is a deformity influenced by multiple factors.
For instance, it is affected by mimics. When the laughing muscles are activated, they compress the fat mass in the cheek like an accordion. As a result of this compression, the skin and subcutaneous adipose tissue at the border of the mouth and cheek become thinner due to repeated pressure, thereby leading to a wrinkle.
Another key factor in the formation of the nasolabial fold is the sagging of the cheek mass as a whole. As the cheek droops, it moves not only downwards, but also towards the center of the face. When you manually move the cheek mass up and out, you can observe that the nasolabial fold grows smoother. Facelift surgery is the way to permanently achieve what you have manually done.
The nasolabial fold is also strongly influenced by the bony skeletal anatomy. In individuals with maxillary retrusion, this fold becomes deeply prominent at a very early age. Particularly in the aging process, tooth losses may cause the nasolabial fold to become more pronounced. If you have a relative with a removable dental prosthesis, observe their face when the prosthesis is in place and when it is removed. When the prosthesis comes off, you can suddenly observe that the nasolabial fold deepens, the upper jaw retracts, and the face looks 5 to 10 years older in seconds. Supporting the upper jaw with dental prosthesis or surgically placing a paranasal implant on the bony surface there can significantly correct the nasolabial fold in accordance with the anatomy. In cases where the nasolabial fold is caused by an underlying skeletal defect, you cannot achieve an effective improvement in the nasolabial fold no matter how much you pull it with facelift surgery.
Another key factor in the formation of the nasolabial fold is the volume changes in the subcutaneous adipose tissue. Particularly in individuals who gain considerable weight on the cheeks and then lose that weight rapidly, the skin that stretches and expands during the overweight period sags when weakened. In a group of patients severely losing weight, the nasolabial fold may not be effectively eliminated even by facelift surgery. In such cases, it may be necessary to excise the fold in a way to leave a dermal scar.
It should be emphasized at this point that all methods reducing the subcutaneous adipose tissue volume of the cheek may cause the nasolabial fold to become more pronounced/deeper. I mentioned in my previous articles that bichectomy, facial liposuction, fat-dissolving mesotherapy and energy-based applications which cause subdermal heat damage and dissolve the fat tissue might deepen the nasolabial fold in the months following the procedure.
The simplest way to treat the nasolabial fold is to fill the relatively hollow triangular area located on the inner side of the fold with the nasal wing forming the upper edge and the nasolabial fold forming the outer edge. This process quickly and effectively reduces the depth and visibility of the fold. However, it should always be remembered that filling the nasolabial fold in individuals with a severely-drooping face can create an amorphous facial structure that lacks aesthetic angulation and contour transitions.
My academic research areas include how to increase the effect of facelift surgeries on the most central parts of the face and how to improve the permanence of this effect.
Since we pull the face laterally in classical face lift (skin lift) surgeries, the force we apply has limited impact on the nasolabial fold, which is near the center of the face. “Extended subcutaneous” approaches separating the skin from the base up to the nasolabial fold are effective in correcting the nasolabial fold, but (1) they risk dermal blood circulation, (2) the nasolabial fold, which is located farthest from source of the tensile force, is the first symptom that recurs when the skin loses its tension and stretches in the post-operative period. Deep plane surgery also has its own limitations. I know you may be confused after reading this paragraph. I covered technical points and I don’t intend to teach you plastic surgery.
I just want you to know how hard we contemplate even such a limited space. As a solution to this problem, I developed a surgical technique. I presented it at our national congress in 2018. The name of this technique, which will soon be published in medical journals, is “Double Level SMAS Plication”. This is a facelift surgery technique designed for patients whose signs of aging are concentrated around the mouth. You can see examples on my Instagram account. I will cover the details of this technique in a separate article.
I hope I have been able to explain that the nasolabial fold is not a simple phenomenon that can be handled with the “grab a needle & fill in the skin” approach.
If you are uncomfortable with the prominence/deepening of the nasolabial fold and would like to get information about treatment options, please feel free to contact us.
Take good care…
… of yourself and your beauty.