The armamentarium to battle the recalcitrant nasolabial fold

The nasolabial fold is the consequence of thinning of the skin, ptosis or deposition of fat laterally, and presence of excess skin. The ideal procedure for combatting this defiant and undesirable aging change would be to eliminate the excess skin, add to the thickness of the skin under the crease, and shield the bands from adherence to the dermis, with or without repositioning or resection of the fat laterally. However, under particular conditions, the patient or physician may choose alternative techniques. These include injection of fat, addition of fat graft, or direct excision. Patients with extremely thin skin are better candidates for direct excision, whereas those with thicker skin may more suitably benefit from fat injection or fat graft.