[Direct excision of the deep nasolabial fold: a logical and easy surgical management]

Surgical management of the deep nasolabial fold, due to age, genetic diseases or facial lipoatrophy, is difficult and often short-lived. Direct excision seems to improve the long-term results. Clinical illustration and review of literature about the anatomy and physiology of the nasolabial fold are proposed to explain this fact.

Direct excision of the nasolabial fold has been performed on nine patients, three females and six males. The problem was aging midface in two cases, facial lipoatrophy in five cases, cutis laxa in one case and pachydermoperiostosis in one case. The excision was sitting astride the nasolabial fold and the suture preserved a dog-ear at the upper extremity to restore the projection of the cheek. Evaluation items were quality of the scar, durability of the result and personal improvement.

Scars were always unnoticeable within six months, projection of the cheek was restored, and results were durable with an average follow-up of eighteen months. All patients were satisfied with the aesthetic or social improvement.

Direct excision of the nasolabial fold is a simple, reliable and durable method, respecting the physiology of this area of the face. Then, it should be indicated in deepened nasolabial fold, whatever the etiology.