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Nasolabial folds
05.21.14 01:10 PM


Do your nasolabial folds bother you?

A very common complaint, this crease or wrinkle develops from the skin just lateral to the lower nose and continues towards the corners of the mouth. It can be deep and sharp, can be very noticeable even in younger faces, and gives the appearance of sagging facial skin hence the appearance of age. 

Fortunately it can be treated in multiple ways: fillers, subcision, surgical excision, or even a face lift. As you can imagine, filler is by far the most common. In case you are not familiar, filler is injected under the skin to fill the wrinkle. The most common fillers are the hyaluronic acids (Restylane, Juvederm, and Belotero) and calcium hydroxyapatite (Radiesse). They are injected with a needle, with local anesthetic, in a short office procedure. See the below pictures. 

Two people are shown with different folds, and even asymmetry of folds on the same face. Not the upper before/after pictures of the younger fold. From the frontal view the fold nearly disappears giving a totally different impression of the face. 
 
In the following pair of pictures note that the folds are much more established. After filler placement (one vial per side) they are softened but do not go away. The area of the jowl, chin and sagging facial skin are not changed but the wrinkles are softer. 

What can go wrong? Nodules, bumps, lumps, imperfections, infections and asymmetries are the most common problems but rarely seen. The FDA does classify filler as a biologic implant even though the above fillers resolve completely with time. 

One can see why filler is a popular option: it takes minimal time, it works well and the risks are very small. Filler can be used in multiple sites around the cheeks, upper face, jaw line and even the hands (Radiesse).

What is not effective for treating the nasolabial folds? As the nasolabial fold is not caused by a muscle, using a botulinum toxin like Botox is not a very good option. However, in unusual situations facial imbalance and asymmetry can be treated with botulinum toxin (see article on Bell’s palsy for more information). Furthermore, skin treatments on the surface and fat grafting have not proven to be very effective, partially as it is difficult to get a graft to survive in an area that moves. 
 
Subcision is a technique where the fold is raised from below, then filled so that it is not tethered. Such a procedure can be an option for deep folds when a person wants to address only that area, not the whole face. 

Face lift can improve the fold but usually not as much as filler or direct excision. A face lift generally improves the jowl much more than the nasolabial fold. If the jowl and its wrinkle bothers a person the most, a face lift may be the better option. If the jaw looks better, the whole face looks less aged. 

The last option is direct excision of the fold. Under local anesthesia around the fold, excision of skin is done to remove the fold and flatten the surrounding skin. A dramatic and permanent result can be attained but some makeup is required to conceal the redness of the scar for a few months. 
  
This option best suits people who have little jowl and don’t want to go through even a weekend face lift. 

In summary,  the options can be complex even for what appears to be the simplest problem. Come in for a visit to discuss the options!

If you have any questions or would like more information, please contact us at 828-268-0082, email us, or use our online request form.


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