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Authors : Dr. Shourya Sharma, Dr. Natasha .

Today dentistry is changing hands very quickly. As correctly said by one of the greats of Indian dental fraternity, one has to see which is the new hype cycle at the present time. And at the present day, Botox and Fillers are the new hype cycle.

Nasolabial folds are commonly known as smile lines or laugh lines are facial feature. They are the two skin folds that run from each side of the nose to the corner of the mouth. It is defined by the facial structure that supports buccal fat pad.
 

What causes nasolabial folds?

The most significant factors in addition to the chronological ageing that contribute to the prominence of the fold are:
  • Excess skin

  • Skin thinning

  • Excess cheeks fat

  • Ptosis of cheek fat

  • Volume loss

  • Muscle action

At younger age we can see that the nasolabial folds as slightly depressed lines and in some cases they may not visible. As we age the depression lines deepen and visibility of the fold increases thus making a person look older.

Nasolabial folds can be of three types mild, moderate and severe.

This common saying is especially true for the nasolabial folds. Deepening of these creases is one of the signs of aging in the midface. Conversely, softening these lines through various interventions results in a rejuvenated appearance.

There are many techniques available for reducing the prominence of nasolabial folds. As with so many other problems in dermatology, the existence of multiple therapeutic options implies that the perfect treatment has yet to be discovered. However, while each treatment has its own limitations, with care and practice you, the dermatologic surgeon, can lessen the effects of an aged appearance due to deep nasolabial folds.

A common approach taken to reduce prominent nasolabial folds is to use a filler substance. This method addresses the dermal atrophy associated with aging that contributes to the development of the nasolabial fold. When using a filler substance, consider the quality of the skin, the depth of the fold, the patient’s goals regarding degree and longevity of correction and the patient’s risk tolerance.

Dermal fillers have a very specific function unrelated to other medical corrective procedures. By directly injecting a naturally derived or synthetic material into the frown lines between your brows, the deep lines from the corners of your nose to the corners of your mouth, depressions along the jaw line, the sunken areas under your eyes, or the hollowed areas of your face, wrinkles and lines immediately become filled-in and skin is plumped up to the point where the wrinkle, depression, or fold is gone. This improvement can last from 3 months to 2 years or even longer depending on the type of filler used, how you take care of your skin, and how your face continues to age.
 
Figure 1: Nasolabial Folds


The present case, talks about use of dermal fillers for the treatment of nasolabial folds.

There are two primary groups of dermal fillers: synthetic and natural.

Naturally-derived fillers (the most widely known is hyaluronic acid) have a much smaller risk of causing an allergic reaction but reactions can occur. Results are immediate but will only last from just 3 to 18 months and occasionally up to 2 years because the filler eventually breaks down, taking the results, for better or worse, with it. Once the filler starts to dissipate you need to go back in and get more filler injected to maintain results. Most people who get fillers will need at least one follow-up injection within a year.

Aside from allergic reactions fillers also have risks of lumping and migration although this happens infrequently. On the other hand, because the results last a short period of time so do the potential problems.

Synthetic fillers last much longer than naturally-derived ones and are considered semi-permanent though there many who would call them permanent because they really don't dissipate. The wrinkles start to return only because your face continues to age or you continue to get sun damage due to being lax about protecting skin with sunscreen daily.

As with all fillers, synthetic fillers have risks which are pretty much the same as for naturally-derived fillers except the difference is because synthetic fillers are "permanent" the potential problems can be "permanent" as well and are harder to correct.
 
Figure 2: Pre & Post Treatment Photographs
 

The present case was of mild nasolabial folds.

In the present case nasolabial folds of the patient were treated with a hyaluronic acid filler, the product used was Juvederm ultra plus xc . A total volume of 0.8ml of HA-laidocaine was used to treat the case.

Injection technique used in this case was two linear threading injections and one fanning injection per side. All injections were placed medial to the nasolabial folds. Injections started from superior most portion of the nasolabial fold from nose coming down to the extent of the fold.

The injection depth which was placed in the present case was mid-to deep dermis for treatment of nasolabial folds.

To conclude one has to first understand the anatomy of the face and should have knowledge of the material to be used. The use of fillers is effective and minimally invasive. Its time that we incorporate new trends and procedures in our profession.
 

Reference:

  • Journal of Drugs in Dermatology, April 2013, pages 470-475;
  • Aesthetic Surgery Journal, March 2013, pages 414-420;
  • Plastic and Reconstructive Surgery, April 2013, pages 589-596;
  • Journal of the American Medical Association Facial Plastic Surgery, March 2013, pages1-6;
  • Aesthetic Surgery Journal, May 2013, pages 561-575);
  • Head and Neck Pathology, March 2013;
  • Facial Plastic Surgery Clinics North America, August 2012, pages 245-264;
  • Cosmetic Dermatology, Second Edition, Baumann Leslie MD, 2009, pages 191-209;
  • Journal of the American Academy of Dermatology, July 2011, pages 92-96;
  • Facial and Plastic Surgery, February 2004, pages 21-29;

More references are availabe on request.