How to Get Rid Of Those Facial Parentheses (Nasolabial Folds)

Lip Injections - How to Get Rid Of Those Facial Parentheses (Nasolabial Folds)

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One of the most coarse facial areas that bothers many patients is the development of the nasolabial folds, also referred to as the lip-cheek groove, or in a recent television market known as the parentheses. You can argue either it is a fold or a groove but it is probably closer to a fold. It develops as the cheek tissue from above ages and begins to sag....falling over its border with the upper lip. The upper lip is 'fixed' so the overhanging cheek tissue creates the appearance of a deepening fold. With time, aging, and the anatomy of one's face, this nasolabial fold extends south past the projection of the mouth and sometimes nearing the lower border of the jaw in ultimate cases of skin laxity.This area is ordinarily treated by injectable fillers and in my convention as many patients wants their nasolabial folds treated as they want their lips enlarged.

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Lip Injections

The most coarse method for nasolabial fold allowance is with injectable fillers. Like all filling procedures by injection, the results from nasolabial fold allowance is quick, easy to do, and the results are immediate. I regularly achieve them under a local anesthetic block so the treatment is as comfortable as possible. While all of the injectable fillers will work, I think some are better for this area than others. And the ones that I think are best are those that last the longest and have the greatest 'push'.

While all of the hyaluronic acid fillers such as Restylane or Juvaderm will work, they do not last as long as any of the particulated injectable fillers. Currently Radiesse (ceramic beads) and Artefill (plastic beads) are the only two particulated fillers currently available. The evidence is clear, not surprisingly because of their solid bead component, that they consistently last longer than any of the hyaluronic acid fillers. While beaded injections can cause lumpiness and irregularities, this is not a critical cosmetic issue (nor can it regularly be seen) in the forgiving area of the nasolabial fold. Conversely, in the lips this is a distinct matter. Also, because the bead combination makes the injectable material more thick and viscous, I think it provides more push as it goes in resulting in a better cosmetic effect and having to use less injectable filler. Because of particulated fillers longevity and thicker volume, it is my adored injectable coming to the nasolabial folds. This injectable treatment will give a 9 to 12 month result.

There are other treatment options for the nasolabial fold as well. The best way to eliminate them is the one way which is practically never done....cut them out. That gets rid of the fold immediately but also leaves a fine line scar which may only be thorough in an older patient. The other more ordinarily done alternative is to use an implant. I specifically use an Advanta implant for those patients that want a permanent volume solution. A very small incision is made in the nose crease and at the end of the lower fold line. The implant is slide into place from one end to the other. This is a policy that can be done in the office under local anesthesia. An implant coming to the nasolabial fold is a good explication for someone who no longer wants to do injections, doesn't mind the opinion of an implant in their face, or has very deep nasolabial folds which would take a lot of injectable filler volume. My sense with an implant in this area has been quite good but it is not a first line coming for most patients.

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