A Dynamic Analysis of Changes in the Nasolabial Fold Using Magnetic Resonance Imaging: Implications for Facial Rejuvenation and Facial Animation Surgery

Abstract

An anatomic study was performed on living subjects using magnetic resonance imaging (MRI) to distinguish the relative contribution of skin, subcutaneous tissue, and muscle to dynamic changes in the nasolabial fold during facial animation and aging. MRI scans with the face in repose and then holding a full smile were performed in both young and old adult subjects. Anatomic landmarks were identified, and measurements characterizing their position were made on the MRI console. MRI resulted in excellent image resolution of facial tissue planes. Comparison between young and old subjects with the face in repose demonstrated that progressive thickening of the dependent portion of the check fat pad and overlying skin, with no appreciable change in the muscle plane comprising the levators of the upper lip, resulted in a deeper and more acute nasolabial fold in older subjects. In both age groups there was significant shortening of the mimetic muscles with smiling, with the lateral mimetic muscles drawn closer to the underlying facial bones. This was accompanied by redistribution of the cheek fat pad, thereby maintaining projection of surface landmarks within the cheek mass in young subjects with smiling. These findings indicate that in order to diminish the nasolabial fold, surgery for facial rejuvenation should be directed to the skin and subcutaneous tissue planes superficial to the mimetic muscles to the upper lip. In order to recreate a natural nasolabial fold during surgery for facial reanimation, contraction of the levator muscles to the upper lip should result in redistribution of the cheek fat pad without change in surface projection of the cheek mass or upper lip; this can only be accomplished if the reconstructed levator muscle is positioned deep to the cheek fat pad, with its insertion toward the deep (mucosal) surface of the upper lip.

A Volumetric Analysis of Soft-Tissue Changes in the Aging Midface Using High-Resolution MRI: Implications for Facial Rejuvenation

“…115: , 2005 Numerous authors have investigated changes in the aging midface. [1][2][3][4][5] On the basis of objective studies, surgeons have modified their techniques for facial rejuvenation commensurate with their ongoing analysis of changes that accompany the aging process. 6 -8 Therefore, it remains essential to continue to provide quantitative analysis of soft-tissue changes in the midface that occur as we age.…”

SMAS Graft of the Nasolabial Area during Deep Plane Rhytidectomy

“…33,34 This chronic passive pulling of the attachments may explain the thickening of the fat and skin over the nasolabial area on magnetic resonance studies. 35 From the physiologic point of view, the development of the nasolabial fold involves the smiling mechanism, the interaction of dynamic and static soft tissues of the cheek, and variations in facial architecture, all of which combine to form different configurations in distinct individuals. 32 The complexity of the associated anatomy and physiology makes it very difficult to postulate a unique treatment and explains why this region is resistant to rejuvenation.…”

Short-Scar Facelift without Temporal Flap: A 10-year Experience

“…In a recent research, MRI was used to evaluate the relative contribution of the skin, subcutaneous tissue and muscles in the formation of the nasolabial fold while smiling and at rest. It was found that there is a thickening of the inferior region of the malar fat and an expansion of the skin around the same area without changes in the levator muscles of the lip (24). These findings would be related to the fact that during smiling, there is a shortening of the levator labial commisure that produces pressure over the malar fat and the skin inferior to the cheek.…”