In this article we go back to the basics to discuss Nasolabial folds and Marionette lines.
Nasolabial Folds are the lines that run from the corner of the nose to the corner of the mouth, and marionette lines are the lines that run from the corners of the mouth down to the chin. People often notice them as being the first visible signs of an ageing face and often present to an aesthetic clinic to have them corrected with injections of dermal filler.
Treatment of Nasolabial folds or Marionette lines (also known as puppet lines) used to be the most requested dermal filler treatment in our aesthetic practice. The reason I’m calling this article back to basics is because treatment of these two indications with dermal fillers are quite literally the first thing Emma and I, as well as countless other practitioners ever learnt to do when we started in aesthetic medicine. Personally my first 500 treatments were almost certainly just Nasolabial lines and Marionette lines. In the 11 years since Emma and I started practising aesthetic medicine there have been significant milestone developments in our understanding of the anatomy, physiology and psychology of ageing. This has led to a shift from filling these areas specifically, towards a more holistic global facial rejuvenation using multiple techniques in addition to dermal fillers.
The reason we initially changed our approach is because we understand that for the majority of our patients, replacing facial volume globally, rather than specifically to one area creates a more natural rejuvenated look. We’ve been thinking a lot about this recently in Clinetix. We have noticed over the past few years a desire amongst our patients still have nasolabial and marionette correction even after full facial volumetric correction. And this really does make a face seem more youthful, when done well.
The traditional approach for this area of simply filling the skin crease and revolumising the subcutaneous tissues will invariably lead, with repeated and excessive treatments, to a flattening of the natural contour of the face. An unnatural and unaesthetic outcome.
The beauty of reflecting back on our practice now, is that now we can see where we weren’t getting it quite right, and now we can see exactly how we can do it to get the all important natural “untreated” looking aesthetic. We can do this now because of two major developments. Firstly our understanding of the anatomy of the area allows us to correct volume loss exactly where it happens. Secondly the technological developments in dermal fillers mean that we now have medical devices (dermal fillers) that can provide natural looking and feeling results.
Now when a patient requests filler in the nasolabial fold, we appreciate that it really is a fold, not a line. It should be there to an extent and completely lifting it out looks unnatural. Now we get that, we can think of the techniques and fillers we are going to use to lift it back to a natural position.
Drs Simon and Emma Ravichandran are Nationally recognised experts in aesthetic medical treatments and run training courses in medical procedures including nasolabial fold and marionette line treatments from their base at the Aesthetic Training Academy in Glasgow as well as other venues throughout the UK.