Surgical Correction of the Nasolabial Fold: A Critical Review of Rhytidectomy Techniques

Nasolabial fold (NLF) effacement for facial rejuvenation has received a great deal of attention but is still one of the unconquered areas in surgical rhytidectomy. The current review aims to analyze the evidence provided by various surgical face lift techniques related to the long-term correction of NLFs and midface laxity.

A comprehensive PICO (population, intervention, comparison, outcome) search of the PubMed, Embase, and Web of Science databases for face rejuvenation cohort and comparative studies published in the English-language literature from 2000 through September 2025 was conducted in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines.

Sixteen reports were selected for review. They were characterized by extremely variable surgical techniques in terms of dissection plane and extent, together with different vectors of lift and suture fixation, as well as heterogeneous measuring tools and follow-up periods.

Objective data to support a specific face lift technique that results in optimal long-term effacement of the NLF are lacking. Despite conflicting reports, it seems that the effect of extended sub-superficial musculoaponeurotic system (SMAS) and deep-plane techniques has been limited due to the absence or attenuation of the SMAS layer deep to the melo fat pad. The effect of superficial SMAS imbrication may be more favorable. In view of the deeper understanding of midface anatomy and the relationship of fascial planes to one another, there is a need for critical research on the proposed facial rejuvenation techniques, several of which may need to be reconsidered.