The labiomental fold is that horizontal notch or groove below the lower lip. For some it is quite deep, for others it is barely noticeable. While there are anatomical reasons why it’s there (it represents the junction between the horizontal orbicularis muscle and the vertical mental muscle), most people only notice it if they think it’s too deep or prominent. A deeper labiomental crease may cause an undesirable deep indentation or may make the chin appear more prominent than it actually is. For some, it just makes them look older.
Softening of the deep labiomental fold can be easily accomplished with any of the commercially available injectable fillers. The more viscous and durable injectable fillers work best in this area. Treatment volumes are less than the area of the nasolabial fold, for example, generally around 0.5 cc or the value of half a syringe. Injectable fillers like Perlane, Radiesse, or Sculptra produce good long-term but not permanent results.
The deep labiomental fold can also be treated with other types of materials, from natural to synthetic. These include standard dermis (eg, Alloderm or NeoForm), dermal fat grafts (strip fat grafts), fat injections, and synthetic implants. All of them produce a decrease in the fold and some are more effective than others. I do not find dermal fat grafting or fat injections to be as effective as I would have hoped. It is not possible to introduce as large a dermal fat graft as is needed through very small incisions at the side of the folds. Fat injections don’t seem to last long in this area. Dermis processed or tubed synthetic implants (eg, Advanta) work best for long-term results. Whatever material is used, it must be stiff enough to provide a good “push” of the deep crease outward for visible results.
Due to the location of the labiomental fold, there are no bone-based approaches that work. In fact, chin augmentations in some patients with a deep labiomental crease will worsen its appearance by making it “deeper” as the chin tissues advance.
Treatment of the labiomental fold is best with injectable fillers for a temporary effect or a synthetic implant for a more permanent solution.