What it means for a patient
- No face lift technique has been shown with objective data to give the best long-term improvement of the nasolabial fold.
- Deeper techniques may not reach the fold well because of the anatomy beneath the cheek fat.
- Ask what a surgeon expects for your nasolabial folds and what evidence supports it.
- Limits: 16 varied reports with different measures and follow-up, so the conclusions are tentative.
Why this paper matters
It reports that extended sub-SMAS and deep-plane lifts appear to have limited effect on the fold, and calls for critical research on current techniques. It links the limited effect to midface anatomy.
Overview
Softening the nasolabial fold remains an unsolved goal in face lift surgery. The authors searched PubMed, Embase and Web of Science for cohort and comparative studies from 2000 through September 2025, following PRISMA guidelines, to see what the evidence shows for long-term correction of the fold and midface laxity.
Findings
- 16 reports were selected.
- Techniques varied widely in dissection plane and extent, lift direction and suture fixation.
- Measuring tools and follow-up periods were inconsistent.
- Objective data supporting one technique for long-term fold correction are lacking.
- Extended sub-SMAS and deep-plane techniques appear to have limited effect on the fold, which the authors attribute to an absent or thin SMAS layer under the melo fat pad.
- Superficial SMAS imbrication may be more favorable.
- Several proposed techniques may need to be reconsidered.
Terms
- Nasolabial fold: the crease that runs from the side of the nose to the corner of the mouth.
- Effacement: flattening or softening of a fold.
- SMAS: the superficial musculoaponeurotic system, a fibrous and muscle layer under the facial fat.
- Sub-SMAS: beneath the SMAS layer.
- Deep-plane technique: a face lift that lifts the skin and SMAS together as one flap.
- SMAS imbrication: overlapping and stitching the SMAS to tighten it.
- Melo fat pad: the cheek fat pad next to the nasolabial fold.
- PICO: a way to frame a research question by population, intervention, comparison and outcome.