The Truth About Nasolabial Folds

Dear Dr. Yang,

When I see women on TV and in the movies who have obviously had face lifts, I notice they have no trace of nasal-labial folds. Is this possible with just a facelift? Or is it a combination of facelift, fillers, fat transfers, etc.?

Is it possible to do just as good a job on a f/l with sedation as with general anesthesia? Some surgeons have told me yes. I would be interested in your opinion.

Thank you,

Hi bjbj,

I’m assuming that you are referring to Joan Rivers. If we look at her smiling, she actually had more of a smile line when she was in her 30′s-40′s than she does now.

Image Source:

I think a facelift, even with a full cheeklift/midfacelift will only give limited nasolabial fold (smile line) improvement. A more natural result can be achieved by performing a “less tight facelift” and use fillers in moderation to soften the smile lines. If you try to “eliminate” the smile lines it will look unnatural.

In people in their 20′s it is possible to have no smile lines when their face is at rest.

Image Credit:

However, when they smile, the will create a very distinct and sharp smile line, in the expected area.

Image Credit: … on/images/

If you look back at Joan River’s current smiling photo, you can see how the smile line is not forming naturally, and appears to be filled. But it does look really good when she isn’t smiling. Although we can’t be sure Joan River’s first non-smiling photo wasn’t Photoshopped to erase the line completely.

It’s not fair for regular people on a fixed income to try to compete or achieve a result that celebrities use hundred of thousands of dollars in maintenance injectables (Botox/fillers) and cosmetic surgery to achieve, then still need magazine editors to further eliminate imperfections in their magazine spreads. It’s their job to look good. If you look at the photos that the Papparazzi take versus the same celebrities on magazine covers, it is a world of difference. Unfortunately the rest of the world looks more like the Papparazzi photos. Makeup, lighting, and Photoshop can make anyone look amazing.

“A natural looking facelift” and “complete elimination of all lines” is not compatible. It will depend on your definition of a good facelift. Some people want a facelift that makes them look as great as possible but without making it look like they are trying to look good. These people have facelifts and no one really thinks they had one, they just wonder. It’s like that saying, “Every woman has her secrets” or something to that effect. The results are not obvious and “in your face.” They just look great.

On the other hand, if your definition of a great facelift is to see how many lines and wrinkles are eliminated, then that is a different way to gauge how successful a facelift is. In the latter case, most people can tell that they had a facelift. These people don’t necessarily get the same compliments as the people with natural looking facelift results.

The problem then becomes that people want all their lines eliminated by the best possible surgeon using the best possible facelift technique, and never need to ever use temporary injectables again, yet they want to look natural and not have anyone know they had something done. If this is the case, that person will most likely be disappointed with their results, no matter how much improvement there is objectively.

Expectation management is just as important as the surgeon’s skill and aesthetic eye. If a surgeon is constantly promising the world, and performing excellent facelifts, they will actually still come short of their promise. For example, “Don’t worry, with the XYZ cheeklift as part of your facelift, your smile lines will be completely gone.” Yet if there is a 60-80% improvement in the smile lines, the patient will only complain that the smile lines were not eliminated as promised.

Is it possible to do just as good a job on a f/l with sedation as with general anesthesia? Some surgeons have told me yes.

Yes it’s possible. Some surgeons may feel uncomfortable if the patient is under IV sedation because they may move around, so in that case, maybe the surgeon is better off with their patient under general anesthesia so they are completely immobilized. It really depends on the surgeon’s comfort level.


Dr. Yang