The labiomental fold is the horizontal indentation below the lower lip that is located at about 1/3 the distance between the lip and the chin. It has various morphologies being quite deep in some while in others being barely noticeable at all. It exists anatomically because tt represents the junction between the horizontal orbicularis muscle and the vertical mentalis muscle attachment to the bone. For this reason it lies exactly opposite the depth of the anterior mandibular vestibule intraorally.
Besides the aesthetic consequences of its depth, the labiomental fold can be a source of tightness or stiffness after intraoral chin surgeries. Whether it is for a sliding genioplasty or a chin implant, the intraoral approach disrupts the attachment of the mentalis muscle that lies underneath the labiomental fold. With healing and scar tissue formation combined with increased projection of the chin, the labiomental fold area can feel tight and interfere with lower lip movement.
While healing and scar maturation will usually solve most labiomental fold problems, patients who have had multiple chin surgeries may not improve with time. Injections such as steroids and various types of hyaluronic acid-baed fillers can be tried and may be effective.
But a tight and restrictive labiomental fold may require surgical treatment. While the labiomental fold may be released of its scar contracture, that alone would be inadequate. For just releasing it along will result in recurrent scar contracture. The space that is created by its release must be filled with new healthy tissue. The logical choice for tissue replacement would be a fat graft. Dermal-fat or strip fat grafts can be harvested from many different locations but the abdomen is by far the most common donor site.
The labiomental fold is released intraorally by separating the fat layer below the skin from the underlying mentalis muscle. This is released from one side of the labiomental fold to the other. Into this tissue defect a fat graft is laid into place. The tissue beneath the mucosal layer over the graft is closed with a final mucosal closure over it. This will create not only a scar release but will soften the depth of the labiomental fold as well.
Fat grafting the labiomental fold is an effective strategy for both releasing a scar contracture as well as reducing its depth for aesthetic benefit.
Dr. Barry Eppley
Indianapolis, Indiana