The labiomental fold is an indentation between the lower lip and chin which anatomically represents the attachment origin of the mentalis muscle to the bone. While everyone has a labiomental fold it varies in depth from near non-existant to a severe V-shaped indentation due to various anatomic causes. Jaw/chin deficiencies, inclination of the lower teeth and the size of the soft tissues chin pad call all contribute to a deeper than normal depth of the labiomental fold.
One of the more common causes of a deep labiomental fold is a Class II occlusal relationship. The lower jaw is underdeveloped and the lower teeth may be proclined forward. This causes the lower lip to roll forward deepening the labiomental fold beneath it. Even if the teeth are orthodontically realigned to a better position on the bone the depth of the bony sulcus remains below the tooth roots remains more concave (deeper).
Treatment of the deep labiomental can be done by a variety of different augmentation techniques of either the soft tissue or the bone. By far the most common approach is soft tissue augmentation with injectable fillers or fat. Various materials have also been used as subcutaneous implants. Less commonly performed is bone augmentation of the sulcus underneath the fold as it is a more invasive procedure and a bone graft would rarely be justified for a small facial augmentation problem.
In a rare case of bone grafting for the deep labiomental fold I had a patient who was undergoing rib removal surgery for waist narrowing as well as chin reshaping surgery. This made available ample bone (rib) and muscle tissue for potential use. As part of her chin reshaping surgery, which was done through an existing submental incision, she desired a less deep labiomental fold. Options included using a rib or muscle tissue graf to place into the exposed bony sulcus above the more projected chin bone. In the end I elected to place a shaped rib graft onto the bone covered by a piece of latissimus dorsi muscle. The immediate effect was a significant reduction in the depth of the labiomental fold. Longer term results will determine if such tissue grafts will be maintained.
Dr. Barry Eppley
World-Renowned Plastic Surgeon