The nasolabial fold: a challenge, a solution.

A prominent nasolabial fold results from a combination of relaxation and thinning of the facial skin and selective fat deposits lateral to the fold. The surgical approach described herein has been used to correct the pronounced nasolabial fold for the last 3 years. First, the temple 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 nasolabial fold due to the more advantageous proximity. Second, a strip of fat is added under the fold in the subcutaneous plane (immediately under the fold) after extensive undermining of the skin through a rhytidectomy flap. Third, removal of the fat lateral to the fold reduces the 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. Complications 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 through-and-through 5-0 catgut suture. Partial resorption of the graft was considered the rationale for undercorrection in 6 patients (17.1 percent). The remaining 29 patients (82.9 percent) had good to excellent results.