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.

What Is Nasolabial Fold Correction?
There are non-invasive remedies which can be temporary and permanent injectable fillers and the APTOS lift (with thread suspension) to more invasive, surgical means such as cheek pad lifts and lateral 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.

Are 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 achieved.

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

  • Cheek Pad (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.

  • APTOS 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.  

  • Fat 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.

  • Injectable 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.

  • Nasolabial 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.

What to Expect at Your Consultation
After 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 more information. 

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 appointment...

Your Preoperative Appointment
This appointment 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. 

Preparing 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 Preparing 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 day.

How Nasolabial Fold Correction Is Performed
Nasolabial 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.

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.

For mid face lifts please see our Face Lift Section for more information on your options.

The 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.

Risks & 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 Face Lift Section.  For risks regarding the excision technique please read below.

Excision of the nasolabial folds are not without its risks.  Risks and complications may include a negative reaction to the anesthetic (please see out Introduction 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.

The 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.

 


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