Can nasolabial folds be removed if my skin is thick?

Question

I had face lift in order to remove nasolabial folds (I am 47) I also had fat transfer in face, forehead lift, upper lower eye lift, neck lift and chin reduction (which surgeon suggested) Now 8 months post op, my surgeon says reason I still have substantial nosolabial fold more so on one side is because my skin is thick. Shouldn't he have assessed my skin at consult (had 3 ) and let me know then, or even though my skin is thick been able to work with/adjust skin etc for desired result?

Timothy R. Miller, MD · Answer

Naso-labial folds are not removed during a facelift but the fold can be improved.  Trying to aggressively remove 100% of the naso-labial fold during a facelift would require substantial tension across the face and create a very pulled and distorted result; moreover, the result would not last.Naso-labial folds are best treated conservatively with fat augmentation or fillers.  But it should be realized that some amount of naso-labial fold is important to maintain, because the true absence of a naso-labial fold would create a very un-natural appearance in most patients. I hope this helps.

Vincent N. Zubowicz, MD · Answer

Very rarely a patient will benefit from direct excision the nasolabial fold. Without a photograph I have no idea whether there is any indication in your case.

Ronald Schuster, MD · Answer

Nasolabial folds can be extremely difficult to make complately go away. Patients should expect them to be impoved but not necessarily gone. Even babies have a little groove.

Arnold Almonte, DO · Answer

Hi Cheryllyn, sometimes even several consultation visits aren't enough to adequately set the right expectations. I always advise my patients that the word "remove" is too strong. A facelift can definitely "improve" the nasolabial folds, but never "remove" them. Fat injections or fillers can also be used to help in this area. Thick skin generally doesn't slide as easily during a facelift and this may be a reason why the correction isn't a great as you expected. Without seeing your pictures, it's hard to make any suggestions. But you did have a lot of surgery and it's not unusual for the skin to relax with time. You may need touch-up work, which is NOT unusual at all. Talk to your surgeon and he can determine what will work best for you.

Harold J. Kaplan, MD · Answer

Hi Cheryl.  The fact that you have thick skin should not determine whether your practitioner can help with the nasolabial fold.  A facelift and even fat injections are great options to help with this issue.  At this point now that you have done both, perhaps injection procedures with Restylane, Perlane or Radiesse may benefit you.  In some cases a facelift is not enough because it does not replace lost volume.  In addition, fat transfer can sometimes lost the benefits in a short period of time like you are pointing out.  Injection procedures can help with the volume loss and the three products mentioned are all worthwhile considering.To see examples of before and after pictures Orange County, CA patients that have used Restylane for nasolabial folds, check the link below.

Vartan Mardirossian, MD · Answer

The facelift is not a procedure designed to resolve nasolabial folds. They can be addressed by a procedure called midface lift which is performed nowadays by few surgeons. Along with fat transfer and fillers the nasolabial folds can be removed permanently with the help of a dermal-fat or a SMAS graft

John Michael Thomassen, MD · Answer

Nasolabial folds are improved in the facelift procedure by the tightening of the skin.  This will flatten out the fold depending on how much tension is placed.  However, too much tension is not ideal due to poor wound healing and scarring so surgeons must make a compromise to improve the fold yet allow proper healing.  Skin thickness typically does not play a role in how much the fold is improved; however, your particular case may be different.  Best wishes!

Michael I. Echavez, MD · Answer

A facelift frequently will not remove nasolabial folds completely, but can improve them.  It is difficult to give you the best advice without examining you or seeing pictures of you before and after your procedures.  Also, without knowing the details of your surgery, it is hard to advise you.  There are procedures, other than a facelift, that can sometimes help to reduce the appearance of nasolabial folds.  You may want to discuss other options with your surgeon or get a second opinion.

Robert H. Hunsaker, MD · Answer

Nasolabial folds rarely have meaningful lasting improvement from the lift alone. Typically either filler or even direct excision will be necessary for the most change. Surgeons need to be careful not to "overpromise" on the amount of change expected in the NLF with facelift alone.

Lewis Ladocsi, MD, FACS · Answer

Hi Cheryllyn.  Nasolabial folds cannot be removed, but they can be improved through volume replacement (fat-grafting, juvederm or other options) and repositioning mid-facial soft tissue.  I presume that your results will improve as your postoperative swelling resolves.  Good luck!

Can nasolabial folds be removed if my skin is thick?

Answers (17)

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