Treating Nasolabial Folds - Surgical and
The nasolabial folds are
the deep folds which run from the side of the nose to the corner of
the mouth. This is one of the first signs of aging - although
younger people with prominent fatty cheek pads may also have prominent
nasolabial folds. It is one of the most difficult
areas/complaints to correct and can depend on several factors,
including fatty cheek pads, dermal fissures from overly
animated faces (smiling), skin elasticity and thickness and downward
cheek pad migration. Sadly, I am getting these.
There are non-invasive
remedies which can be temporary and permanent
fillers and the APTOS lift (with thread suspension) to more invasive, surgical means such as cheek pad lifts and
face lifts. There are even newer mid-face lifting techniques which
have proven to its effectiveness. Some patients choose nasolabial
implants which are removable/reversible until a better means comes along.
Please seek several opinions (several consultations) to go over your many
options. Not all surgeons will offer all or even a portion of your
options. Research through the Internet and speak with real patients who
have undergone the particular techniques you are considering.
You a Candidate for Nasolabial Fold Correction?
First and foremost,
an individual must be in good health, not have any active diseases or
pre-existing medical conditions and must have realistic expectations of the
outcome of their surgery. Communication is crucial in reaching one's
goals. You must be able to voice your desires to your surgeon if he/she is to
understand what your desired results are. Discuss you goals with your
surgeon so that you may reach an understanding with what can realistically be
You must be
mentally and emotionally stable to undergo an cosmetic procedure. This is an
operation which requires patience and stability in dealing with the healing
period. There is sometimes a lull or depression after surgery and if
there is already a pre-existing emotional problem, this low period can develop
into a more serious issue. Please consider this before committing to a
procedure. It the above describes you and you have
the desire to rid
yourself of loose sagging skin of the face and neck, you may be a good
candidate for Nasolabial Correction.
Your Options In
Nasolabial Fold Correction
(Mid-face) Lift: This area is the first to start betraying your
age. My cheek pad is falling, joy. I am beginning to show
nasolabials and a general downward-sliding appearance to my cheeks. It
can also cause under eye hollows, which I have as well. Quite frankly,
this is one of the next items on my list. You can also have suture
suspension as well. There are several techniques, some which anchor
your tissue and some which require temporary percutaneous suspension
(through the skin, visibly) I don't like those as it can leave scars.
Thread Lift: Considered less
invasive, this procedure was invented in
1999 by Russian cosmetic surgeon, Dr. Marlen Sulamanidze.
The procedure utilizes blue, cogged thread (suture) material threaded throughout
the face in specific application methods. The threads run along
certain lines to anchor themselves into the tissue. The lifting effect
is at its peak several months later when the collagen has formed around the
threads. Some surgeons have described it as more of a bunching result
than a lifting effect. This is still a relatively new procedure and
the long term effects are unknown. Reportedly they can be removed,
however not without inherent risks and complications. Some patients
have reported visible bluing of the skin where the APTOS thread
has been implanted superficially. Some have reported blue
pimples which are actually the ends of the thread poking through the
original puncture/insertion mark. As with all surgery, asymmetry is
possible, as well.
Grafting: Fat can be injected into the nasolabial folds as well
although great care should be taken in this choice. Realize WHAT
causes the Nasolabial and fat loss is usually not it. Adding fat can
look unnatural in many cases when the face is animated. Fat can also
migrate and cause a heaviness which can drag the area down even more so.
This is not to say it does not work, because I have seen wonderful results
from nasolabial fat injections -- IO am just saying use caution and choose
your surgeon wisely.
Fillers: As with the above, injections of any material can be
problematic. One must consider the real cause of the problem and not use a Band-Aid
to fix a problem which needs addressing from an entirely different angle -
vertical lifting. Also permanent injectables take on a whole new
problem themselves as granuloma formation can become an issue. Silicone
& Artecoll injections can cause lumps in some individuals requiring
surgical excision and natural tissue loss. This is not to say all
persons will experience this but it DOES happen.
Fold Excision: This procedure is usually reserved for very severe
nasolabial folds in mature patients with thicker skin. The procedure does
leave a visible scar so take your body's scar-forming ability into
consideration. If you keloid or scar badly whatsoever, obviously this
procedure would not suit you.
to Expect at Your Consultation
checking a few surgeons' backgrounds and credentials, you will make an
appointment for a consultation. You will meet with these surgeons and discuss
your goals and you will disclose all information regarding your health; if you
smoke, what medications or vitamins you presently take, etc. -- this is very
important. You really should consider smoking cessation as this can
significantly decrease healing. Visit
the Medication & Supplements List for
You will discuss
your complaints and concerns and discuss the various looks one can achieve,
the amount that can be corrected, etc. Your surgeon will explain the technique
and incision placements for removal or implantation/augmentation methods that
may be most appropriate for you. he or she should discuss the risks
associated with nasolabial fold correction with you, as well.
You will also
discuss the available anesthesia that will be used for your procedure. Most
nasolabial fold correction procedures are performed under Light Sleep
Sedation, Twilight or regional -- sometimes even local with oral sedation.
However, some surgeons may use General IV Sedation for actual surgeries.
Either way, discuss this beforehand as many people are not aware of the risks
of Anesthesia. If you do go under Deep General, ascertain that the
anesthesiologist is certified. Please read the
All About Anesthesia Page -- the risks regarding anesthesia should be
considered for a fully informed choice.
If you would like
more information on consultations or a list of questions to ask your surgeon
please visit the Consultation Help Page.
If you should choose to book or reserve a surgery date you will usually give a
deposit to hold your surgery date. Most times if you cancel a few days
beforehand, this amount is non-refundable. After paying your deposit and
scheduling a surgery date, you will also schedule a pre-operative
addresses more questions you may not have thought to ask at the initial
consultation, such as more surgical details, concerns and even ascertaining
that your surgeon is aware of what you desire from your procedure. Just
as your surgeon will make certain that you know what it realistically possible
from this procedure.
You will also
discuss your pre-operative instructions and speak about the recovery period
instructions and what to expect in the months ahead. You will be given
prescriptions for antibiotics, pain relievers, perhaps blood pressure
medicines, prescription anti-inflammatory drugs and perhaps a box or
directions for gaining a box of Arnica montana. Would like to
know more on the benefits of Arnica montana?
Perhaps you will be instructed to obtain Bromelain
or other types of remedies, although many surgeons would rather have you not
take ANYTHING other than your prescription medications, please do not go
against your surgeon's wishes. Remember, always ask your doctor before taking
any of these products.
Please do not
hesitate to address any concerns that you may have during this time and even
after your pre-operative appointment. If you remember something when you get
home or the next day or even the day of surgery -- don't be afraid to ask.
for Your Surgery
You should be given
a pre-operative information packet that explains everything you should do and
know before your surgery date. The packet should include a list of all
the medications you should not take starting usually at 2 weeks before
your surgery. These medications will include, but are not limited to, aspirin
containing products, stimulants, seratonin supplements, etc. Would you like to
view a typical Medication & Supplements List?
We have a printer-friendly version as
well. Also, if your surgeon advised that you may take Arnica montana,
Bromelain, Vitamin K, etc. for swelling and bruising you should either have
this in your packet or begin shopping for your necessities.
It is quite
possible that you will have preliminary blood work performed. This is
normally an extra out-of-pocket expense that the patient must participate in
to check your white and red blood cell count (complete blood count, CBC) which
may ultimately alert your surgeon to disease or
disorders beforehand. If you are a female they may take an extra vial for a
pregnancy test. Some surgeons ask that you have physical. This can be yet
another out of pocket expense so ask at your consultation what will be needed
when you are quoted a price.
So many things to
do... so little time. Surgery will be here before you know it so visit the
For Surgery page and relax. This section contains, printer-friendly pre-op
lists, tips and advice as well as things you must do to prepare for your big
Fold Correction Is Performed
fold correction procedures vary with technique. If you are getting
simply injections -- this usually only takes less than half an hour and perhaps
a little bruising and swelling is included in your recovery. Please see
our Injectable Fillers Section for more
information on your options.
Synthetic implants may also be an option
but for this area, injectables and lifting procedures are often utilized.
The mouth area is highly animated and synthetic implants can be quite
If you are having
an excision procedure, you may or may not be sedated. This depends upon your
surgeon's protocol. The surgeon will inject the area locally and excise
the nasolabial fold from your face and re-suture the area up with hairline
sutures. You will be instructed to keep your treatment area very still
to encourage proper healing. Excision is used only for very severe
nasolabials, and most patients only require volume restoration or a
combination of volume restoration ad lifting procedures.
For mid face lifts please see our
Lift Section for more information on your options.
Road to Recovery
If you were sedated, you may
be groggy from the anesthetic and/or oral medications and probably won't
remember much of the first day or two. You will have to take it easy and sleep
on two pillows to keep your head elevated for 7 to 14 days - or however long your
surgeon suggests. As the days go on the swelling and pain will dissipate.
There may be bruising and swelling but this tenderness will go away, as
well. So make a mental note of this or you may be shocked into a depression.
Bruising and swelling are a normal occurrence in most surgeries.
The recovery for
nasolabial excision is pretty minimal. Although one must be very careful not
to excessively speak or animate the face so that the sutures are not disturbed
and excess scar tissue does not form. You should be able to alleviate this
discomfort with your prescribed pain medications. If you have excessive pain,
redness, pus or other symptoms that do not appear normal, contact your surgeon
immediately! Take your temperature regularly. An elevated temperature
could mean an infection. Take those antibiotics on time. Also, don't
forget if you are a female taking birth control pills that some antibiotics
can interfere so in the event that you do have relations, use another form of
protection as well.
Even though you may
feel better, you must take it easy for the first 3 weeks. Be careful not to bend
over or lift heavy objects. And be careful not to raise the blood pressure for
at least 3 weeks as this could cause internal bleeding at your treatment area.
Your blood vessels dilate to allow increased blood flow when you raise your
heart rate. This may cause problems at internal wound sites. Do not
participate in contact sports for at least 6 to 8 weeks -- although ask your surgeon
what he recommends specifically.
You may notice odd
sensations of tightness, tingling, the sporadic sharp pain, or pulling, burning, and cold sensations. These usually subside within
the first few weeks. Some patients experience a lull or down
period where they become depressed or feel unattractive. This is very normal.
Please print out our Emotional
Preparation Sheet so that you will be able to remind yourself that you
will get through your low period.
If you have had
injections there is usually no recovery -- just swelling and/or bruising may be
present in the first weak.
& Complications of Nasolabial Fold Correction
Depending upon the
technique -- the risks and complications may differ. To learn about the risks of
injectables please see our Injectable Fillers
Section. For risks regarding the mid-face lift, please see the
Lift Section. For risks regarding the excision technique please read
Excision of the
nasolabial folds are not without its risks. Risks and complications may
include a negative reaction to the anesthetic (please see out
to Anesthesia Section for more information). Other risks include
infection, seroma, hematoma, asymmetry, incision puckering, scarring,
hypertrophic or keloidal scarring, hypo and hyperpigmentation of the scar,
incomplete correction of the nasolabial folds and general dissatisfaction.
Average Prices of Nasolabial Fold Correction
The approximate costs
of a nasolabial fold correction procedure varies significantly due to treatment
options. Please see our respective sections regarding these options
outlined above for their appropriate prices. Excision procedure may cost
anywhere from $2,000. to $4,000.US and will vary according to region and surgeon.
General anesthesia or hospital operating room costs will also add to this price.