Should I Have My Nasolabial Folds Cut Out?

Q: I am 53 yrs. old and have very deep nasolabial folds (more so on one side than the other).  I don’t know why they are so deep at my age but they are. I was interested in the “Cutting out” of the fold, however, my question is what happens to the cheek? Would the skin not sag? This is a problem I have and am very self conscious about it.

A: The development of nasolabial folds occurs in everyone as they age, some are more pronounced than others. How deep and early nasolabial folds appear is a function of numerous factors including thickness of one’s facial skin, thinness or fullness of one’s face, cheek bone support and how much cheek soft tissue sagging or ptosis develops. The nasolabial fold develops as the cheek tissues sag down over the more fixed and stable upper lip region. They are really tissue that is ‘falling over the fence’ so to speak.

By far, the most common treatment for softening the nasolabial folds are injectable fillers. But in advanced stages of nasolabial folds, an inverted-V deformity exists in the skin and injectable fillers do not produce  a significant or worthwhile reduction. Usually inverted nasolabial folds are seen in older patients. (> 60 years of age)

In the inverted V or deep nasolabial fold, excision is a treatment option. Because this technique cuts out the fold, it is very effective at restoring a smooth transition between the lip and the cheek again. However, there is a trade-off of a scar which make proper patient selection critical. While this fine line scar does quite well, it is a scar nonetheless and that deformity trade-off is not right for everyone.

Another treatment option for the deep nasolabial fold is a ‘release and fill’ technique. A fine surgical wire is used to release the dermal attachments of the fold and an interface of injectable fat placed under the release. While this sounds like it would be theoretically successful, long-term follow-up has not borne out this theory.

Before considering nasolabial fold excision, one may want to try injectable fillers to be certain that their effect is not sufficient since they are reversible. Nasolabial fold excision is a one-way commitment.

Dr Barry Eppley

Indianapolis, Indiana