THE SURGICAL ANATOMY OF THE NASOLABIAL FOLD

Objective, The purpose of this cadaver dissection study was to investi gate the anatomy of the nasolabial fold with a view to explaining the problems of surgical softening or elimination of the fold. Study desig n. Ten formalin-fixed cadavers and 6 fresh-frozen cadavers were used f or this study. In 12 cadavers (8 formalin-fixed, 4 fresh-frozen), the nasolabial fold was sectioned at right angles to the fold for histolog ic examination, and in 4 cadavers (2 formalin-fixed, 2 fresh-frozen) t he epithelium was dissected off the fold to allow for more detailed gr oss examination of the underlying musculature. Results. The fold was c learly identified on 14 of the cadavers but was indistinct on 2 on gro ss examination. Beneath the fold were 2 muscle bundles. The more super ficial muscle runs parallel to the fold whereas a deeper muscle runs a t right angles to it. The buccal fat pad lies above the fold and appea rs to be retained by horizontal septae in the fat pad and also by the musculature of the fold. Cadavers showing a poorly defined nasolabial fold had fewer muscle bundles to support the fat and fewer fibrous sep tae running through the fat. Conclusions, The nasolabial fold is defin ed by structures that support the buccal fat pad and hold it above the fold. This appears to be a combination of muscle bundles that run bot h across and parallel to the fold and also by fibrous septae supportin g the fat pad. This has implications for the development of surgical p rocedures to soften or eliminate the fold, which must separate the mus cles from the dermis of the fold and allow the fat to descend and soft en the fold.