Nasolabial folds

Perioral dermatitis is characterized by erythema, scaling and small papules and pustules symmetrically distributed around the mouth, sometimes extending to the nasolabial folds and the cheeks. This condition typically occurs in females 20-40 years of age. Topical corticosteroids can exacerbate the disease and should be avoided. 

Zinc deficiency is clinically characterized by the development of a moist eczematous dermatitis most apparent in the nasolabial folds and around orifices. Other presenting signs and symptoms may include hypogeusia (blunted sense of taste), alopecia, diarrhea, rash (which may vary from papular, scaly lesions to weeping, open erosions), apathy, and depression. Clinical zinc deficiency occurs most frequently in the setting of abnormal losses, such as in Crohn s disease, malabsorption states, and fistula losses, or from prolonged inadequate intake, such as with zinc-free parenteral nutrition. 

Figure 23-6 Seborrheic dermatitis in a classic distribution at hairline and between eyebrows and nasolabial folds. (From Habif TP. Psoriasis and other papulosquamous diseases. In Clinical dermatology, a color guide to diagnosis and therapy, ed. 4. Philadelphia Mosby, 2004 244.)...

Sagging skin only responds to a phenol peel and only if the skin is relatively thin. Peels are not indicated for sagging in thick skins or for nasolabial folds. Chemical peels cannot compete with surgical face-lifts they cannot stretch the skin as well as the latter do. 

The more severe the photoaging, the more important it is to consider the depth of the peel. The patient shown in Figure 5.7 has a light skin type that is sensitive to the sun s rays. She has developed a number of solar lentigines and fine wrinkles caused by UV rays. The eyelids are very wrinkled and the nasolabial folds and marionette lines are slack. 

Botulinum toxin often has to be used at the same time as a deep peel on patients with thick skins in order to limit the contractions of the orbicular muscle of the Kps and to improve/maintain results. The horizontal fold between the lower Kp and the prominence of the chin does not usuaUy respond weU to peels, even deep ones, ft can easily be filled in, however, together with the nasolabial folds 1-2 months after the phenol peel. 

Folds cannot be treated by peels, and require surgery, dermal fillers or thread lifts. Deep nasolabial folds and marionette lines do not always respond to phenol. 

The nasolabial folds only respond to phenol if they are light and the skin is thin. 

The same patient taken during the same consultation (a) without flash and (b) with flash relief and lip wrinkles are flattened by the effect of the flash. The nasolabial folds, on the other hand, are more clearly visible with flash. 

Fixed erythema, flat or raised, over the malar eminences, tending to spare the nasolabial folds Erythematous raised patches with adherent keratotic scaling and follicular plugging atrophic scarring may occur in older lesions... 

FIGURE 94-9. Seborrheic dermatitis with involvement of the nasolabial folds, cheeks, eyebrows, and nose. See Plate 9. (Reprinted with permission from Freed-betg IM, et al, eds. Fitzpatrick s Dermatology in General Medicine, 6th ed. New York, McGraw-Hill, 2003, p 1199.)... 

Hyaluronic acid improves elasticity and viscosity of synovial fluid. It is indicated in the treatment of pain of osteoarthritis of the knee in patients who have failed to respond adequately to conservative nonpharmacologic therapy and to simple analgesics (e.g., acetaminophen) and mid to deep dermal implantation for correction of moderate to severe facial wrinkles and folds, such as nasolabial folds (Restylane). 

SCORE 1 Minor paralysis (flattened nasolabial fold, asymmetry on smihng)... 

Facial paresis (ask patient to show teeth or raise eyebrows and close eyes tightly) SCORE 0 Normal symmetrical movement 1 Minor paralysis (flattened nasolabial fold, asymmetry on smiling) 2 Partial paralysis (total or near total paralysis of lower face) 3 Complete paralysis of one or both sides (absence of facial movement in the upper and lower face)... 

Lindqvist C, Tveten S, Bondevik BE, Fagrell D. A randomized, evaluator-blind, multicenter comparison of the efficacy and tolerability of Perlane versus Zyplast in the correction of nasolabial folds. Plast Reconstr Surg 2005 115 282-289. 

Carruthers A, Carey W, De Lorenzi C, Remington K, Schachter D, Sapra S. Randomized, double-blind comparison of the efficacy of two hyaluronic acid derivatives, restylane perlane and hylaform, in the treatment of nasolabial folds. Dermatol Surg 2005 31 1591-1598 discussion 1598. 

Recently, cross-linked gels of HA have transformed the esthetics and dermatology areas. These HA-based products are remarkably safe and serve as tissue-bulking agents to correct wrinkles and other skin defects. Restylane (27-29), Hylaform (30-33), Captique (34), and Juvederm M (35) are a few representative examples of HA-based dermal fillers that have been approved for skin depression in nasolabial folds. 

Arsiwala SZ. Safety and persistence of nonanimal stabilized hyaluronic acid fillers for nasolabial folds correction in 30 Indian patients. J Cutan Aesthet Surg 2010 3(3) 156-61. 

Galadari, H., Van Abel, D., Al Nuami, K., Al Faresi, F., Galadari, I., 2015. A randomized, prospective, blinded, split-face, single-center study comparing polycaprolactone to hyaluronic acid for treatment of nasolabial folds. Journal of Cosmetic Dermatology 14. 

Most common complications are small granulomas approximately 2 mm in diameter that show spontaneous remission in 3 years [150,155,156]. Despite the available publications considering the technical aspects of PLA filler and immediate results, concern remains about the long-term results and the durability of the procedure, mainly for cosmetic purposes [155,156]. Salles [157] evaluated a 3 years follow-up investigation into the effect of PLA implant injection for the treatment of sunken nasolabial folds (Fig. 7.17). 

Figure 7.17 A 53-year-old patient who underwent PLLA filler injections for sunken nasolabial fold treatment, (a) Pretreatment (b) After one session (c) Attenuation of the nasolabial fold 6 months after treatment (d) Still some degree of permanence of effect 36 months after treatment [157]...

In experimental pellagra, which was induced in three human subjects who received a corn diet which furnished 4.7 mg. of niacin and 190 mg. of tryptophan daily, findings included dermatitis, glossitis, stomatitis, bloody diarrhea, and mild mental disturbances. " In addition, cheilosis, angular stomatitis, and dermatitis of the nasolabial folds were observed, lesions commonly found in riboflavin deficiency, yet the diet furnished 2 mg. of riboflavin daily. The occurrence of similar lesions in deficiency of niacin and riboflavin reflects the close metabolic relationship of these vitamins. 

Cosmetic filler injections into the glabellar region or nasolabial fold can cause retinal artery occlusion. Iatrogenic ophthalmic artery occlusion is associated with painful blindness, a thin choroid, brain infarction and poor visual outcomes, particularly when autologous fat is used. Ophthalmic examinations and systemic brain magnetic resonance imaging (MRl) should be performed in patients with ocular pain after such injections. 

The authors concluded that clinicians should be aware of the possible excessive ingestion of carrots, especially in the presence of localised yellow-orange skin changes in the nasolabial folds, palms of the hands and soles of the feet. 

Sensitive areas like the inner canthus of the eyes and nasolabial folds can be protected with Vaseline. The peeling agent is then applied with a gauze or cotton-tipped applicator. 

Figure 16.13 To avoid demaratlon lines In the perioral region, the peel should oontinue to the nasolabial fold and treat the entire oosmetio unit...

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