Your Questions

Q: Dr. Eppley, It appears that very few plastic surgeons offer a permanent solution for labiomental fold treatment (reduction). After reading your case study on the subject, and considering other options, I’ve decided to either address this issue with Silikon-1000 a permanent filler, or with an implant which I prefer. You would be my choice of surgeons for the implant. But I have one problem. As far as I’m concerned, I do not want any scars, regardless of how small or imperceptible they may be. My question to you is… Would it be possible to have the implant put in place from inside the mouth rather than through small incisions on the skin?

A: Labiomental fold treatment (reduction) is a challenging procedure and I would not refer to any treatment of it as permanent since facial aging is a progressive procedure. I would not recommend a subcutaneous labiomental fold implant be placed through an intraoral incision. Besides not being able to get it in the ideal place, there is going to be a higher risk of infection dragging the implant through oral mucosa. I think an implant is the right procedure for labiomental fold reduction, just not placing in through the mouth.

Dr. Barry Eppley

Indianapolis, Indiana

 Q: Dr. Eppley, I saw a doctor for a genioplasty consultation and he is supposedly a guru in the field. I have Class II, deep v shaped labiomental fold and my lower lip is behind my upper and my chin height is short and retruded back. He said a sliding genioplasty to horizontally and vertically lengthen my chin will work, but he also said he wanted to inject some kind of new stem cell bone material on my chin underneath the fold which will create new bone and fill in the valley on my chin, which would push out the soft tissue of the fold. I’ve never heard of this. He said bone augmentation was superior to soft tissue implants or fillers, and that this technique is very new.

A: What you are referring to is the simultaneous management of a deep labiomental fold during a genioplasty. Even though vertically lengthening the bony chin with the horizontal advancement will not deepen the fold any further, it is also unlikely to make it more shallow either. Filling in the bone gap of the osteotomy, while often thought as helping push out the labiomental fold area, does not. It is below the level of the labiomental fold. Thus a soft tissue approach is needed to help fill out the deep labiomental fold. That can be done by a variety of methods from injectable fillers, fat injections, allogeneic dermal grafts, and even silicone rubber (Permalip) implants. So-called stem cell injections (usually just concentrated fat injections) is a hot topic for injectable soft tissue augmentation. It is certainly a safe technique to do but its effectiveness is far from established.

Dr. Barry Eppley

Indianapolis,Indiana