Most people notice mid face aging when the nasolabial grooves become deeper. The marketing campaign by Juvederm about fixing your ‘Parentheses’ brought attention to it. However, most public and physicians did not understand in the beginning the reason behind formation of these nasolabial folds or grooves. Here is the reason. As we get older we loose bone in all of our body.
The same happens to facial skeleton as well. As the cheek bones get smaller they sink into the face and cannot hold up the soft tissues that used to make a beautiful apple cheek in our younger years. It is obviously exacerbated by the loss of elasticity in the soft tissues. As the tissues descend towards the lower jaw and lips they end up creating a fold called ‘Nasolabial Fold’ also known as ‘Nasolabial Groove’ or Smile lines.
So this makes it very clear that the loss of cheek volume comes first and then the nasolabial fold. Hence the chicken came first or the egg mystery has been solved. Next the issue is how to treat it. I always leave it to the patient to decide. If they want nasolabial folds to be softened only then any filler will achieve that.
However a better or more aesthetic approach is try restoring the structure of the face to what it used to be. To achieve that a filler should be used to rebuild the cheek bones to lift the tissues back up from the nasolabial folds to the apple cheek area where they belong. This works very well in the early aging years. With time it can be quite advanced and you need to approach the nasolabial fold directly as well. This issue has been addressed by mid face lift as well.
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