Nasolabial Folds and the Mid-face

by Peter T. Pacik, MD, FACS

The mid-face is the central, inner zone of the face extending from the bottom of the lower eyelids to the nasolabial folds and from the sides of the nose to the cheekbones and cheeks. It is full and vibrant in youth, blending well with the lower eyelids. There is no break between the eyelids and the inner face. With facial aging, the fat in the midface both disappears and drops downward towards the nasolabial folds causing the nasolabial folds to become more prominent and the mid-face flattened. This creates a break in contour between the inner cheek and the upper lips. Add to this the appearance of a trough along the inner lower eyelid (nasojugal depression), and/or fatty bags involving the lower lids, then you have an additional break in contour and signs of an aging face.

Dawn, in her mid 30's demonstrates a youthful face as shown on the left. Facing aging is obvious in a 44-year-old patient as shown on the right. The left photo shows excellent blending between the lower eyelids and the mid-face. There is no break in contour between the two. On the right, nasojugal folds along the inner lower eyelids create a break between the lower eyelids and the inner face. In addition, there is volume depletion with a loss of fat involving the inner face and the remaining fat has descended creating nasolabial folds. This is in contrast to the photo on the left showing full volume along the inner face with good support of the fat and no nasolabial folds. Creek bones are well developed in the photo on the left and are somewhat deficient on the right.

A variety of mid-face surgical procedures are available to help lift the descended fat to more favorable locations and at the same time to create blending with the lower eyelids so that a single smooth unit is created from the eyelids to the mouth. These procedures carry risks of injury to the lower eyelids and potential nerve damage. In the volume depleted patient, one “steals from Peter to pay Paul” by transferring the precious little fat in the lower portion of the mid-face to build the upper mid-face.

Our current approach to restoring the volume of the mid-face is by fat grafting and/or injections of Radiesse. This improves the nasojugal depressions, enhances the cheekbones, and lifts the nasolabial folds. We prefer to start with a temporary facial filler such as Radiesse which is a product that lasts about 1 to 2 years to make sure the patient likes the improved appearance. We follow this with fat grafting to the area, and supplement with additional fill as needed to avoid having the face return to its original state. We follow our patients closely, and add additional fat or facial filler as needed to maintain the mid-face rejuvenation. Fat or Restylane can be added to the lower lids for volume depletion in this area, or to create a smoother contour between the lower lids and the inner face.

The nasolabial folds on the left and the loss of volume in the upper lip are signs of facial aging. Facial filler, such as Restylane, Radiesse and fat grafting, helps restore volume in the inner face, lifting the nasolabial folds, and adding bulk beneath the nasolabial folds. In addition, volume was added to the upper lip and specifically under the lip lines to help restore a more youthful lip.

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The Plastic Surgery Center of Manchester, New Hampshire specializes in cosmetic plastic surgery, including body lifts, breast enlargements, breast lifts, breast reductions, eyelid surgery, ear surgery, facelifts, fat grafting, liposuction, neck and chin surgery, rhinoplasty (nose surgery), surgery after massive weight loss, and tummy tucks. We also offer facial rejuvenation (chemical peels, dermabrasion, Obagi Blue Peels, Glycolic Peels, Microdermabrasion), injectables and facial fillers (BOTOX® Cosmetic, Radiesse®, Juvederm®, Perlane® and Restylane®) and advanced skin care to patients from all over New England (Maine, Vermont, New Hampshire, Massachusetts). While no responsible practitioner gives guarantees for the work they do on the human body, we can at least reassure you that you will receive the expertise and dedication of over 30 years in practice. Our patients become an important part of our family and we try to get to know each patient individually and customize their treatment to meet their desires.