What options do I have to fix my labiomental folds?

Question

I'm interested in smoothing my mental crease as it appears that my lower lip protrudes more than my chin or that i have a large lower lip. When i smile the crease is less visible. in it's natural position it is fairly prominent. I have done some research and would consider an intraorally placed fat graft a lower lip reduction or some kind of implant to the mental crease area.i had xrays taken at a dentist and was told i have a normal bite so i don't believe that is the cause. Open to suggestions

Nelson Castillo, MD · Answer

Thank you for sharing your question.  Though nothing replaces an in-person examination it appears that a combination of chin augmentation and lower lip reduction would best help address your concerns.  Hope this helps.

Robert M. Tornambe, MD · Answer

pavkristie.  It appears from your photographs that your best option would be lower lip reduction, as this would decrease pull of the area of your concern.  This will decrease prominence of your labio-mental mental fold. The fold can possibly be blunted somewhat with filler within the fold as well. Seek the opinion of a board-certified plastic surgeon in your area to explore all options. Good luck

Barry L. Eppley, MD, DMD · Answer

Your options would include the following, lower lip reduction, labiomental fold augmentation with a fat graft and vertical chin lengthening. Each of these have their advantages and disadvantages. But the reason your labiomental fold looks deep is because of a combination of a larger lower lip and a vertical lyshort chin...the fold is simply sandwiched between these two other issues.

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many facial shaping procedures using dermal fillers, silastic facial implants (cheek, chin), liposuction and/or facelifts for over 30 years.  From the photos, your chin is very weak.  This lack of forward projection of the chin causes the lips to appear like they overly protrude.  Filling in the mental creases with any filler (fat is the least reliable filler which is discussed below) would cause the chin to appear flat thereby pushing the lower face further out of balance.  I have performed many facial shaping procedures, including Chin Augmentation with dermal fillers or silastic chin implants, for over 30 years.  When the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy, the lower face looks short, de-emphasizes the lips and allows early formation of a "double chin".  
 Proper placement of a silastic chin implant adds forward projection to the chin thereby creating harmony and balance to the lower face.  Using the same incision, liposuction can be performed to reduce the fat and further shape the neck.  Excess skin, from below the chin, can also be removed through the same incision.  
 I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick, highly effective and far less invasive than a sliding genioplasty (requires extensive tissue dissection, bone cuts and placement of metal screws and plates to secure the cut segments of bone).  I perform chin implant surgery in 30 minutes or less, often using a local anesthetic alone.  In my opinion, you are a good candidate for chin implant surgery.  If you are not ready for a chin implant, the chin can be augmented with precise placement of a dermal filler.  Once the chin is properly augmented, the mental crease can be softened using a dermal filler. I have performed many facial shaping procedures using dermal fillers, facial implants (cheek, chin), liposuction and/or facelifts for over 30 years.  In my experience and despite its recent increase in popularity, fat transfer (fat injection) offers "far" less of a reliable and predictable volume for facial shaping than an off the shelf dermal filler or silastic facial implant.  For that reason, I do not use fat to shape the cheeks, chin, lips or jaw line.  Tissue physiology is quite simple.  Tissue requires a blood supply in and out as well as lymphatic connections to remain viable and alive.  Once fat is removed from the body all of these things have been disrupted.  Just because the removed fat is mixed with PRP or something else doesn't make the blood and lymphatics magically re-appear.  The fat at that point is not living tissue which means that it's prone to being dissolved by the body (most likely in an uneven and unpredictable manner).  Injecting fat back into the face does not create the required elements to make the fat living tissue once again.  So the argument that fat is alive and viable in the face once it's been removed and re-injected makes no sense to me as a physician and surgeon.
 The other issue that I have with fat transfer is the lack of precision.  Fat is thick by nature which means it's not the same consistency as an off the shelf dermal filler.  Fat injections use an increased volume injected in an attempt to compensate for the volume loss that "will" happen.  This means a lack of specific shape and volume that simply can not begin to compare with the specificity of using a silastic facial implant of a "known" shape and volume.  In that regard fat offers too much of an unknown to make it a reliable and predictable method for facial shaping.  There's a significant difference between a 3mm and 5mm thick cheek implant.  You can imagine the magnitude of difference there is between retaining 60% of 25cc's of fat versus 35%.  In my humble opinion, I just don’t see how fat could possibly be used to precisely shape facial features?
Hope this helps.

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