The Naso-Labial Fold..Is It Normal??

Many of the most recognisably beautiful women have definite Naso-Labial folds.

It does not detract from their beauty.

However not a week passes at our clinic without requests for treatment of a patients naso-labial fold. Sadly this focus remains an unfortunate obsession amongst many cosmetic patients and often a poorly understood phenomenon in our profession. The genesis of the fold is complex and multi-factorial. Fundamentally the naso-labial fold (and the labio-mental {marionette} grooves below) deepen due to contraction (or atrophy/involution) of the teeth and bones surrounding the mouth.
Filling these depressions with injectable fillers and even relaxing them a little with muscle relaxant injections can improve them a little, but not for long. If you place a finger on the naso labial fold you will feel the root of the tooth only millimeters under the skin. So there is very little distensible tissue for a filler to go. So what is the answer? There is a growing appreciation that treatment of the cheeks above and the lips below focuses the eye's attention to the aesthetic improvement in these far more important regions of beauty (and as a bonus can also indirectly improve the folds).
Furthermore some minimally invasive per-cutaneous tissue lifting through tiny skin punctures can improve the aesthetics a little further. The most famous plastic surgeon in history, Professor Ivo Pitanguy recognised this issue in 1999. The conclusion from his published paper on "Round Lifting" is reproduced below as well as a little history of this illustrious colleague.

Treatment of the Aging Face Using the “Round-lifting” Technique
Ivo Pitanguy et al
Department of Plastic Surgery, Pontifical Catholic University of Rio de Janeiro, Brazil
Aesthetic Surgery Journal, Volume 19, Issue 3, May-June 1999,

"There is as yet no ideal solution for the surgical correction of the naso-labial fold component of the aging face. However, all of the techniques described are considered safe and have precise indications. It should be stressed to the patient that the nasolabial fold is part of the anatomy of the face and that the goal of treatment is to soften the appearance of the fold, not to eliminate it completely."


"Ivo Pitanguy is famous throughout the world, but in his native Brazil he’s a legend, eclipsed in public recognition only by Pelé, the soccer god. That a plastic surgeon could reach this level of renown says something about the Brazilian worship of physical beauty and, of course, Pitanguy’s knack with the knife, for which he’s been dubbed “the Michelangelo of the scalpel.” But the doctor clearly possesses other, more subtle qualities as well. “Pitanguiser,” a word coined in the local Portuguese dialect, translates as “human charisma, intelligence and compassion.” In our harshly clinical Nip/Tuck culture, Pitanguy has said he sees his business as “the search for harmony between body and soul.”
Read More http://www.wmagazine.com/beauty/2008/07/ivo_pitanguy#ixzz1R36OHbG6