Deep Nasolabial Folds Research Articles

Zygomaticus Major Advancement as an Adjunct to Lower Blepharoplasty

Sagging of the mid-face, deep nasolabial folds, and flat malar eminence often compromise the rejuvenation effect produced by upper and lower blepharoplasty. A simple surgical technique based on advancement of the zygomaticus major origin was developed as an adjunct to lower blepharoplasty to address this problem. The technique is predominantly suitable for ambulatory surgery setup and can be easily performed under local anesthesia and sedation. It offers rejuvenation of the midface and correction of the nasolabial fold.

A Surgical Solution to the Deep Nasolabial Fold

A Surgical Solution to the Deep Nasolabial Fold

A surgical solution to the deep nasolabial fold.

A persistent problem for restoration of youthful appearance is the nasolabial fold, despite the many techniques that have been proposed for its improvement. The anatomic assessments have led me to use the technique described herein, which is certainly not the final solution but which at the moment produces a significant improvement if it is done properly. It is a simple procedure that can be done on an outpatient basis or at the same time as a face lift.

Subperiosteal Transblepharoplasty Composite Cheek Lift Without Lateral Canthal Modification

It has been recognized that the aging deformity of the midface and infraorbital area is characterized by descent of the eyelid skin below the orbital rim, an inferiorly displaced and prominent nasojugal fold, ptosis of the cheek pad, and a deep nasolabial fold. To address these changes a central facial technique using a transblepharoplasty subperiosteal approach with suspension of the cheek mass combined with a formal canthoplasty has been reported. This technique, and others, showed improvement in the aging face by repositioning and lifting the lower eyelid skin above the orbital rim, raising the malar fat pad, reorienting the nasojugal fold, and softening the nasolabial fold. In an attempt to simplify the procedure of raising and lifting a subperiosteal cheek composite flap, we have employed the use of a transblepharoplasty subperiosteal cheek lift without the use of canthopexy or canthoplasty. The operative technique is described. Excellent results have been achieved with a low complication rate.

Buccal Fat Pad Pedicle Flap for Midface Augmentation

Midface aging is characterized by soft-tissue ptosis with loss of cheek projection. Subperiosteal midface lifts may reposition the soft-tissue mounds and improve the tear trough, but may not fill the lateral cheeks in patients with significant jowls or poor bony support. Correction with alloplastic implants is helpful, but may not be accepted by many patients. During subperiosteal midface lifts, the author often excises Bichat's fat pad to decrease the jowl and to diminish face fullness. He has modified this approach and used a vascularized Bichat's fat flap to aid lateral cheek projection while still improving lower face fullness and the jowl. For the last 4 years, close to 150 patients undergoing subperiosteal midface lifts have had vascularized Bichat's fat pad flaps. The jowls were marked preoperatively. All patients had complete cheek undermining either through a buccal sulcus incision or through a crow's-foot incision, or through a muscle-sparing limited lower blepharoplasty incision. Bichat's fat pad is identified in its pocket medial to the masseter tendon. Mobilization of Bichat's fat pad is done by blunt dissection, preserving its thin fascial envelope. The "hernial saclike" pocket, excluding Stensen's duct and the buccal branches of the facial nerve, is identified and protected. Suspension is accomplished by fixation with 3-0 polydioxanone sutures either to the temporalis fascia (via the temporal incisions), to the arcus marginalis, or to the suborbicularis oculi fat pad. Fixation technique is dependent on where the fat pad is needed and the surgeon's preference. Fat pad repositioning is accomplished with a minor learning curve. The most common problems are tearing of the fat pad during fixation and temporary numbness of the long buccal nerve. Attention to leaving the capsule intact and gentle handling is essential to fixation. Nevertheless, in some patients with poor-quality fat pads, fixation is extremely difficult. Four-year results have been excellent. Further studies with magnetic resonance imaging of postoperative patients are necessary to assess longevity. Bichat's fat pad provides autologous vascularized tissue for midface fill. Placement may be lateral for cheek augmentation or medial for deep nasolabial folds. Jowl improvement also occurs with the removal of Bichat's fat pad from its pocket.

Direct Fixation of the Malar Pad

In most patients, the upper portion of the subcutaneous fatty mass--the malar pad--is modest in size and only moderately displaced inferiorly. Mobilization of the malar pad together with the ovelying skin flap achieves a pleasing result in these cases. Occasionally a patient will present with very prominent and ptotic malar fat pads and deep nasolabial folds that cannot be adequately addressed by existing methods. This article describes a technique of malar pad suspension by direct suturing that preserves the blood supply to the pad while placing it in a higher, more aesthetic position.

A surgical solution to the deep nasolabial fold.

A persistent problem for restoration of youthful appearance is the nasolabial fold, despite the many techniques that have been proposed for its improvement. The anatomic assessments have led me to use the technique described herein, which is certainly not the final solution but which at the moment produces a significant improvement if it is done properly. It is a simple procedure that can be done on an outpatient basis or at the same time as a face lift.

The subperiosteal approach for the correction of the deep nasolabial fold and the central third of the face: Ramirez OM. Clin Plast Surg 22:341, 1995

The subperiosteal approach for the correction of the deep nasolabial fold and the central third of the face: Ramirez OM. Clin Plast Surg 22:341, 1995

Anterior Malo-Labial Face-Lift: Technique and Indications

The correction of a thickened and deep nasolabial fold and commissural and juxta-commissural buccal lesions constitutes one of the principal difficulties of the malar phase of a cervicofacial face-lift. However, the correlation of these lesions is important as ptosis of the nasolabial fold and labial commissures is an almost constant early sign of aging. This correction is the objective of the anterior malo-labial face-lift.

The Subperiosteal Approach for the Correction of the Deep Nasolabial Fold and the Central Third of the Face

The nasolabial fold is one of the most difficult problems to correct with the traditional skin-SMAS rhytidectomy. This article presents a technique for the correction of the deep nasolabial fold and the central third of the face. Key steps of the operation include (1) a wide subperiosteal dissection with extension under the intermediate temporal fascia and the fascia of the masseter muscle, (2) subperiosteal release of the lower margins of the malar and maxillary areas, and (3) upward lifting and fixation of the deep structures in an almost vertical orientation. These surgical principles can be applied to the open, pure endoscopic, or endoscopic-assisted biplanar facelift.

Mimetic modulation for problem creases of the face.

Problem creases of the face such as frontal lines and frown lines, crow's feet, deep nasolabial and perioral folds, and cervical bands may be caused by the aging process, excessive exposure to the sun, disease, or genetic disposition. The condition may become aggravated by habitual hyperkinesia of certain mimetic muscles like the frontalis, corrugators, orbicularis oculi, levatores labii superioris, zygomatici, and the platysma. The diagnosis is established clinically by electromyography and selective muscle and nerve blocks. In these cases we advocate regulation of the mimetic hyperkinesia through selective myotomy, myectomy, and neurotomy of the responsible mimetic muscles (mimetic modulation). These procedures may be performed exclusively or in combination with a blepharoplasty, rhytidectomy, or other procedure. Our experience with 60 patients over the past five years (medium = 3.5 years) is presented. Problems and complications such as paresthesia and hypesthesia, partial paresis and asymmetry, incomplete correction, and recurrences are discussed. We believe that mimetic modulation is a valuable concept in treating problem creases and thereby improves the results of the aesthetic surgery of the face.

Clinical and Electromyographic Features of “Intermittent Tonic Facial Spasm” due to Acoustic Neurinoma

The authors report two cases of acoustic neurinoma involving intermittent tonic contractions of the facial muscles on the affected side. The clinical features, and in one case the electromyographic (EMG) findings, were compared to those in cases of hemifacial spasm (HFS) due to neurovascular compression (NVC). Both patients exhibited intermittent facial tonic muscle contractions and deep nasolabial folds on the affected side despite facial weakness. In one case, EMG showed continuous muscle activity not only during contractions but also at rest. On the other hand, in HFS due to NVC, EMG demonstrated intermittent bursts of activity during spasm but little or no activity at rest. In both of these cases the tumor was large enough to compress the brainstem. In neither case could the facial nerve be identified during subtotal tumor removal. These findings suggest that the nature of the facial muscle contractions in these two cases was quite different from that of HFS due to NVC. The former appeared to be an incomplete form of the so-called “continuous tonic facial spasm” attributable to glioma of the brainstem. Such contractions might better be termed “intermittent tonic facial spasm.”

A technique of nasolabioplasty.

There are several techniques available for the improvement of the deep nasolabial folds. The standard face-lift operation is the most acceptable and popular technique as it leaves no scars on the face. Occasionally, the aesthetic surgeon encounters patients who, because of economic or health reasons, cannot undergo the face-lift operation. They may also be too old to want a full face-lift. In these individuals, a nasolabioplasty has been found very useful. The operation may also be used as an adjunct to rhytidectomy in patients with persistent sagging of the cheeks and deep nasolabial folds after a face-lift operation. Two incisions are placed on each side; one precisely on the nasolabial groove and the other lateral to the groove. The amount of skin outlined between the two incisions is proportional to the degree of pull desired. The island of skin between the incisions is not removed. Instead, it is de-epithelialized, rolled on itself into a tube and left in situ under the nasolabial fold to minimize recurrent deepening with time. Other techniques of nasolabioplasty are reviewed. The results of the operation in 14 patients are analyzed, and complications are discussed.

Diminishing facial wrinkles by linear eversion

ONE OF THE areas of the face which has not always benefited from plastic surgery includes the deep nasolabial folds as well as the infralabial and frown lines. Even in a radical rhytidectomy with extensive undermining, these areas have not always responded with satisfactory results. 1 Chemabrasion affects only the superficial (epidermal) layer of the skin and will not always diminish deep furrows 2 ; at any rate, it cannot be extended too close to the nose. 3 Chemexfoliation has been used in the treatment of nasolabial folds in combination with intradermal silicone injection, 4,5 but this procedure entails the risk of foreign-body reaction, hardening of injected substance, or settling into an undesirable pattern. Fomon's technique of inserting a graft from the fascia lata (first described in 1939) involves a relatively radical procedure 6 ; in addition, the implant may have a tendency to drift. This report describes a simple technique of

Diminishing facial wrinkles by linear eversion.

ONE OF THE areas of the face which has not always benefited from plastic surgery includes the deep nasolabial folds as well as the infralabial and frown lines. Even in a radical rhytidectomy with extensive undermining, these areas have not always responded with satisfactory results. 1 Chemabrasion affects only the superficial (epidermal) layer of the skin and will not always diminish deep furrows 2 ; at any rate, it cannot be extended too close to the nose. 3 Chemexfoliation has been used in the treatment of nasolabial folds in combination with intradermal silicone injection, 4,5 but this procedure entails the risk of foreign-body reaction, hardening of injected substance, or settling into an undesirable pattern. Fomon's technique of inserting a graft from the fascia lata (first described in 1939) involves a relatively radical procedure 6 ; in addition, the implant may have a tendency to drift. This report describes a simple technique of

Asymmetrical Conditions met with in the Faces of the Insane; with some Remarks on the Dissolution of Expression

In the case of Ellen D., a female general paralytic in an advanced stage of the disease, whenever she was spoken to her features would be distorted by an exaggerated grin; the eyes nearly closed by the action of the lower part of the orbicularis palpebrarum, mouth opened and its angles retracted, the upper lip excessively elevated showing the gum, the tongue lolled out between the teeth always on the left side, and enormously deep nasolabial folds produced, curving round the angles of the mouth and blending with each other on the end of the chin.