THE NASOLABIAL FOLD - A CHALLENGE, A SOLUTION

A prominent nasolabial fold results from a combination of relaxation a nd thinning of the facial skin and selective fat deposits lateral to t he fold. The surgical approach described herein has been used to corre ct the pronounced nasolabial fold for the last 3 years. First, the tem ple incision is positioned at the anterior hairline rather than in the hair-bearing skin. This permits removal of the maximum amount of skin without concern for posterior transposition of the temple hair, and, more important, it transmits a more effective pulling force to the nas olabial fold due to the more advantageous proximity. Second, a strip o f fat is added under the fold in the subcutaneous plane (immediately u nder the fold) after extensive undermining of the skin through a rhyti dectomy flap. Third, removal of the fat lateral to the fold reduces th e buccal projection and thereby lends an appearance of flatness. This report covers 35 patients (8 males and 27 females) who underwent this problem-oriented approach with an average follow-up of 23 months. Comp lications included one localized hematoma (managed conservatively) and one expanding hematoma (which required evacuation). Two incidents of graft dislodgment were discovered early in the study, following which all grafts were fixed to the overlying nasolabial groove with a throug h-and-through 5-0 catgut suture. Partial resorption of the graft was c onsidered the rationale for undercorrection in 6 patients (17.1 percen t).The remaining 29 patients (82.9 percent) had good to excellent resu lts.