Nose To Mouth Lines-How to Correct the Nasolabial Fold and Restore Facial Volume
Article by Brooke R. Seckel, MD
Boston Plastic Surgeon
Nose to mouth lines or folds are one of the earliest signs of facial aging that make a person feel that their face no longer looks fresh and young. These lines, also called the nasal labial fold line or nasolabial fold line, run from the corner of the nostril of the nose down to the corner of the mouth and begin to show usually in our thirties or forties. Smiling makes these lines look deeper. As we age, the cheek skin falls down or drapes over the nasal labial line to create a fold, the nasal labial or nasolabial fold and creates a tired look to the face.
What causes Nose to Mouth Lines and Folds?
A youthful face is a full face with plump cheeks. A structure called the malar fat pad is attached to our cheek bones high in the face and gives a plump or high cheek bone appearance. As we age our facial skin and supportive structures become lax due to fat atrophy or loss of Fat and the malar or cheek fat pad and cheek skin sag downward toward the mouth and nose.
Essentially, facial aging is due to volume loss caused by atrophy and loss of fat.
Our normal smile muscles are attached to the corner of our mouth. When we smile the pull of the smile muscle creates a line or depression which runs from the nose to the corner of the mouth. This natural line is called the nasal labial or nasolabial fold line. Repeated smiling and facial expression deepen this line throughout life.
As our aging skin and cheek or malar fat pad sag downward, the nasal labial line blocks the downward sag, the loose skin and cheek fat pad fall over the nasal labial line and create a fold of skin-the nasal labial fold or nose to mouth line or fold.
How to Remove or Correct Nose to Mouth Lines
These lines are normal. Most people only seek correction after the lines have deepened because of the sagging cheek and the formation of the nasal labial or nasolabial fold. This usually occurs in our late thirties or forties. There are both surgical and non-surgical methods to correct the nasal labial or nasolabial fold.
Surgical Correction of Nose to Mouth Lines or Folds
Surgical correction is done with either a face lift, cheek lift, or mid-face lift. During these procedures the surgeon detaches the sagging skin and cheek tissue from the face through a surgical incision. The loosened skin and cheek fat pad are then pulled upward and repositioned to a more youthful position higher on the face over the cheek bone. Properly performed face or cheek lift by an experienced skilled surgeon can create a beautiful result.
However, modern facelift often includes Fat Transfer to the Cheek and Mid Face to restore volume loss as well as tighten skin
Non-surgical Correction of Nose to Mouth Lines or Folds-Restore Facial Volume Loss
o Soft tissue Filler Injections-The most common non-surgical method is to inject soft tissue filler into the Nasolabial Fold Line to plump the deep line beneath the Nasolabial Fold. The soft tissue fillers are injectable compounds such as Restalyn(TM), Juvederm(TM), Perlane(TM), Radiesse(TM), and Sculptra(TM) to name a few. This technique plumps and camouflages the line and makes the overlying fold less obvious. Fillers are biodegradable and do need to be repeated at 6 month to one year intervals.
o Midface and Cheek Volume Replacement-This technique also uses soft tissue fillers but they are used to plump the mid cheek area and the cheek bone area. The effect is to plump and lift the sagging cheek and pull the nasal labial fold higher. This technique is called the liquid facelift.
o Fat Transfer- Fat Transfer is a more permanent filling solution to correct Nasolabial Fold Lines and Mid Face Aging. Fat is harvested from an area of fat excess in the body, usually the Hips, Buttocks or Abdomen and injected into the Mid Face Region. A potential, but not yet proven, additional benefit of Fat Transfer is the possibility that Stem Cells present in the Fat can have a secondary skin rejuvenation effect on the overlying skin.
o Skin Tightening with Laser and Light Therapies-There are many new non-surgical skin tightening technologies available. All are based on the concept that if you can heat the deep layers of the skin to 60 degrees Centigrade, the collagen in the skin will shrink and the skin tightens. This deep skin heating has to be achieved while the surface of the skin is cooled, otherwise the skin could be injured. Commonly available machines are LuxIR Deep(TM), Thermage(TM), Refirme(TM), and Titan(TM) to name a few. The best results achieve only a 20% skin tightening, usually not enough to lift the cheek or lessen the nasal labial fold. Certainly not a non-surgical facelift as so often advertised.
o The Future?-Subcutaneous (beneath the skin) laser skin tightening-New laser fiber technologies have recently been developed to melt fat and tighten skin. Today these technologies are used in laser assisted liposuction. These technologies are not yet safe to use in the mid face region. However, in the future, new subcutaneous laser skin tightening techniques may be developed to improve the nose to mouth lines.
Keep a Happy Face- Prevention is the Best Cure for Facial Aging
As in all areas of medicine, health, and anti-aging, prevention is the best cure! Wear sun block, eat healthy, exercise, do not smoke tobacco, do not drink excessive alcohol, and manage your stress. Follow these guidelines and you will have smile lines, not nasal labial fold lines.