Can a facelift incision be made in the nasolabial folds? (Photo)

Question

I had a fat transfer that resulted in too much fat on one side above the nasolabial fold, so the skin has been stretched and sags. I know I could do a facelift and stretch it towards the ear, but that would bring the fat up to the cheekbone, and as a man I dislike big cheekbones. I was wondering if the excess skin can be removed at the nasolabial fold. My folds are pretty pronounced and they don't bother me terribly, so maybe an incision mark wouldn't look much different. Thank you.

David Parizh, DO · Answer

You can do a direct excision to improve the nasolabial folds. However, I think in the right hands you can perform a facelift and not move the fat to give you augmented cheek bones that you do not want.

Donald Groves, MD · Answer

Unfortunately, it is difficult to definitively answer your question without performing a thorough formal physical exam. Although it is possible to place an incision in the nasolabial fold, doing so would create a scar in that location, and the final appearance of your face and the scar would be dependent on how well that heals and your adherence to proper incision/scar care post-operatively. Limited information can be gained from the one photo you have provided- I would need to have more views including the entire face, and higher resolution photos to even have a tentative discussion with you. I would urge you to arrange a formal consultation with one or multiple plastic surgeons to thoroughly discuss your surgical goals, be formally examined, learn about all your options (including nonsurgical), and decide on the best procedure(s) and incision placement for your specific case. I hope this helps!Best, Dr. Donald Groves Plastic Surgeon

Stephen Prendiville, MD · Answer

So, first I want to address a few misconceptions: 1) A properly performed deep plane facelift should not stretch your nasolabial fold toward your ear, 2) A deep plane facelift is self-volumizing and won't give you "big cheekbones" but will redistribute volume to where it used to be. Secondly, in men, sometimes a direct nasolabial fold excision is a good choice of procedure, since the fold really hides the incision well. This is routinely done in reconstructive surgery for skin cancer.

Jacob Tower, MD · Answer

Hello, hope you are well. Thank you for the question and photo. The picture gives a limited view of the issue that you're referring to, but I will offer my opinion. Direct excision via an incision in the nasolabial fold could be designed and performed, but I would not recommend it. On the other hand, a facelift of any kind will not realistically move the fat just above the nasolabial crease as far as the cheekbone, so I would try to assuage your concern with that approach. We can't evaluate your face with a partial view alone, but a facelift is likely your best option to reduce skin redundancy and soft tissue sagging that results in jowling and deep nasolabial creasing. 
Best,Dr. Tower

Tanveer Janjua, MD · Answer

It is possible to excise the excess fat and skin near the nasolabial fold. It is a quick surgery and can be done under local anesthesia. The results are good. Although you have a scar but to the naked eye it usually appears to be your own nasolabial groove. 
Regards
Dr J

Ronald J. Edelson, MD · Answer

There is actually a procedure called “ direct excision of nasolabial folds” it is done in older patients with very deep folds that a facelift will not improve. It’s usually something that’s done in older men and the scar heals invisibly. From your photo I don’t think you would be a good candidate for it

Michael I. Echavez, MD · Answer

Looking at your photo, it seems to me that the main issue is loss of volume in your cheek.  If volume were added to your cheek (above and to the outer portion of the nasolabial fold), this would pull the fold back and improve it.  It does not appear to me that excess skin is the problem.  In cases where excess skin is an issue, an incision can be made in the nasolabial fold to excise the excess skin.  I have commonly performed this procedure.

Zoran Potparic, MD · Answer

It does not look that you have too much skin redundancy in NLF. It is possible that fine liposuction would correct deformity; if not, direct excision of the fold and some fat would create safe correction leaving scar that is less noticeable than fold itself. Hope this helps.

Matt Novak, MD · Answer

A facelift incision is typically not made directly within the nasolabial folds themselves. However, the incisions for a facelift can be strategically placed around the ears and hairline to address sagging skin and tissue in the lower face and neck, which can indirectly improve the appearance of the nasolabial folds.

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