Cosmetic Follow-Up
A Surgical Solution to the Deep
Nasolabial Fold
Claude Lassus, M.D.
Nice, France
I first described the use of Gore-Tex strips to
improve deep nasolabial folds in 1987.1 In June
of 1996, I reported my experience in Plastic and
Reconstructive Surgery.2 Thirteen years after my first
publication, what have I learned about the treat-
ment of deep nasolabial folds with this method?
I have learned that this method provides
satisfactory, long-lasting results (Fig. 1) when
liposuction of the excess fat deposit located
above the fold is performed at the same time. I
have also learned that improvement was some-
times insufficient, most likely because of the
thickness of the Gore-Tex sheets available at
that time (only 2 mm).
This led me to try Softform tubes in 1998.
Softform is, like Gore-Tex, expanded polytet-
rafluoroethylene with only a few physical mod-
ifications.3 Because very few complications oc-
curred with Gore-Tex implants in my
experience, I expected the same with Softform.
Softform comes in tubes, which is interesting
because (1) the tube allows fibrous tissue to
grow into the lumen, fill it, and fix it in place;
(2) the convex nature of the tube seems to
impart greater surface augmentation to soft
tissue; and (3) the three different diameters of
the Softform tubes (2, 4; 3, 2; and 4) allow the
surgeon to find the right implant for each
category of nasolabial fold.
The technique used is exactly the same as
the one described for Gore-Tex strips.2 A tun-
nel is created in front of the fold, and the Soft-
form device is introduced into this tunnel (Fig. 2,
left). Then the canula is removed, and the Soft-
form tube appears (Fig. 2, second from left). The
trocar is removed, leaving the Softform tube in
place (Fig. 2, second from right). Finally, the two
extremities of the tube are cut and buried well
Received for publication March 26, 2001; revised May 29, 2001.
Follow-up to Lassus, C. A surgical solution to the deep nasolabial fold. Plast. Reconstr. Surg. 97: 1473, 1996.
358
below the skin surface, and a stitch is used to
close each opening (Fig. 2, right). Figure 3 shows
the results achieved with Softform tubes. In my
opinion, this method (using Gore-Tex strips or
Softform tubes) is still valuable in the treatment
of deep nasolabial folds.
DISCUSSION
Two categories of people generally seek im-
provement of deep nasolabial folds. The first
category is made up of relatively young people
who want to obtain this improvement without
surgery. These patients have two choices: (1)
injection of absorbable filler, which some pa-
tients accept even if injections have to be re-
peated; or (2) injection of nonabsorbable
filler, which is associated with complications,
some of which can be difficult to control. Until
an ideal filler material (i.e., one that is perma-
nent, soft, nonpalpable, invisible, nonaller-
genic, and poses no harm to the patient) be-
comes available on the market, Softform tubes
are, in my opinion, helpful in the treatment of
deep nasolabial folds.
Softform tubes result in permanent improve-
ment. In addition, if any complication occurs
(e.g., malposition, infection, palpability, visibility,
or dissatisfaction of the patient), the implant can
be removed and will leave no damage, which to
me is the main advantage of this procedure.
The second category of patients who seek
improvement of deep nasolabial folds is made
up of older patients who require a concurrent
face lift and eyelidplasty. Recent anatomic stud-
ies have confirmed that the visibility of the
nasolabial folds is caused by the descent of the
malar fat pad and the overlying skin. These two
tissues are stopped in their descent by the ad-
Vol. 109, No. 1 / THE DEEP NASOLABIAL FOLD 359

FIG. 1. (Left) Original appearance of a deep nasolabial fold. (Right) Appearance of nasolabial
fold 9 years after implantation of Gore-Tex strips.

hesion of the skin to the muscle plane all along
the nasolabial crease, and Youssif et al.4 have
demonstrated that to improve deep nasolabial
folds, one must pull skin and fat. New surgical
techniques have been developed since 1987 to
reposition the malar fat pad, and these tech-
niques should be considered for improvement
of deep nasolabial folds in older patients.
In 1998 I developed a procedure consisting
of pulling the orbicularis muscle in an upward
and a little bit oblique direction during a lower
blepharoplasty.5 This maneuver elevates en
bloc all the soft tissues of the midface and
improves the superior part of the nasolabial
folds while simultaneously correcting excess fat
and skin at the lower eyelid, visibility of the
arcus marginalis, and malar bags, producing a
smooth transition between the inferior eyelid
and the central face (Fig. 4).
CONCLUSIONS
Gore-Tex strips and Softform tubes are still
valuable in the treatment of deep nasolabial
folds in relatively young patients. They pro-

FIG. 2. Procedure. (Left) The Softform device is placed in the tunnel created in front of the fold. (Second from left) After the
cannula is removed, the Softform tube appears over the trocar. (Second from right) After the trocar is removed, the Softform tube
is in place. (Right) After the two extremities of the Softform tube have been cut and buried under the skin surface, one stitch
is used to close each opening.
360 PLASTIC AND RECONSTRUCTIVE SURGERY, January 2002
moved easily with no damage to the patient if
complications occur.
In older patients, the current face lift tech-
niques reposition the malar fat pad, producing
an improvement of the deep nasolabial folds. I
prefer to use the orbicularis muscle pull ac-
complished during a lower blepharoplasty
(Fig. 4), and sometimes I add at the same time
the use of Softform tubes.
Claude Lassus, M.D.
Residence Negresco
1 Rue de Rivoli
Nice, 06000
France
claude@lassus.net

FIG. 3. (Above) Original appearance of deep nasolabial fold
in a 45-year-old patient. (Below) Appearance of the nasolabial
fold 9 months after implantation of a 3.2-mm Softform tube.
duce permanent improvement, and unlike in-
jectable permanent fillers, they can be re-
REFERENCES
1. Lassus, C. Utilisation dun matriau de renforcement
pour le traitement des ridules et des rides du visage.
Presented at the 14th Congres National de Medecine
Esthetique et Chirurgie Dermatologique, Paris, Sep-
tember 2527, 1987.
2. Lassus, C. A surgical solution to the deep nasolabial
fold. Plast. Reconstr. Surg. 97: 1473, 1996.
3. Maas, C. S., Gnepp, D. R., and Bumpous, J. Expanded
polytetrafluoroethylene (Gore-Tex soft-tissue patch)
in facial augmentation. Arch. Otolaryngol. Head Neck
Surg. 119: 1008, 1993.
4. Yousif, N. J., Gosain, A., Matloub, H. S., Sanger, J. R., Mad-
iedo, G., and Larson, D. L. The nasolabial fold: An
anatomic and histologic reappraisal. Plast. Reconstr. Surg.
93: 60, 1994.
5. Lassus, C. Benefits from lifting of the lower eyelid. Aes-
thetic Plast. Surg. 24: 424, 2000.

FIG. 4. (Left) Original appearance of a deep nasolabial fold in a 45-year-old patient. (Right)
Appearance 15 years after a first subcutaneous face lift, 6 years after a second subcutaneous face
lift, and 3 years after a lower blepharoplasty with muscle suspension. Notice the improvement
of the nasolabial folds as well as a smoothing effect in the entire midface.