The ‘mini fan’ and ‘simple interrupted thread’ techniques: a novel method for treating deep nasolabial folds and dynamic discord lines
This article offers a novel non-surgical dermal filler technique to better resolve the appearance of nasolabial folds and dynamic discord lines. It will highlight how traditional filler techniques can be combined with the novel ‘mini fan’ and ‘simple interrupted suture’ techniques to give optimal aesthetic outcomes. The anatomy of the complex topological region of the nasolabial fold and the origin of dynamic discord lines will be explained. It is important to understand the role of changes in the osseus, superficial musculoaponeurotic system, adipose and dermal structure that occur with ageing, to treat these regions most effectively.
Many practitioners understandably find nasolabial folds (NLF) and dynamic discord lines, a challenge to soften and reinforce with nonsurgical enhancements such as dermal filler or skin boosters. The reasons for this are threefold; a) these areas often look very different on static appearance to dynamic, therefore providing treatment that looks natural in both modalities is a limiting factor, b) the appearance of these lines often comes from both a deep, ingrained rhytid in the dermal layer, as well as shadow from a combination of excess volume and loss of volume in the surrounding fat pads, and c) dermal filler selection for treatment of such lines has been historically challenging as many fillers do not have the rheology to seamlessly blend with the skin on expression. Thus if they are flexible enough to stretch with the skin, they may not be cohesive enough to significantly volumise and vice versa. This may lead to visible lumps or underwhelming results respectively. It would follow that in each case, either the dermal rhytid, the lack or excess of volume, or both should be treated, and that filler selection for the surface rhytid needs flexible yet moderately cohesive rheology, depending on the skin quality.
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