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J Cosmet Med 2022; 6(2): 78-83

Published online December 31, 2022

https://doi.org/10.25056/JCM.2022.6.2.78

Changes in smile index after correction of deep nasolabial fold using a combination of polydioxanone thread and hyaluronic acid filler

Hana Kwon, MEd1 , Hyemin Oh, DDS2 , Hyunjee Chae, MD3 , Pattaraporn Thiangthae, MD4 , Kyoung-Jin Kang, MD, PhD5

1Pascal Korea Ltd., Seongnam, Rep. of Korea
2Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Rep. of Korea
3Masterpiece Plastic Surgery and Skin Hospital, Bangkok, Thailand
4Kluaynamthai Hospital Network Clinic, Bangkok, Thailand
5Shimmian Clinic, Seoul, Rep. of Korea

Correspondence to :
Kyoung-Jin Kang
E-mail: safikccs@pascal-world.com

Received: November 23, 2022; Revised: December 5, 2022; Accepted: December 8, 2022

© Korean Society of Korean Cosmetic Surgery

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background: Filler injections are commonly used to soften deep nasolabial folds (NLF) by restoring volume in the depressed parts of fold. Recently, a combination technique using hyaluronic acid filler and polydioxanone (PDO) thread significantly improves deep NLF and induced changes in smile.
Objective: This study retrospectively confirmed the effects of this combination therapy, focusing on smile changes.
Methods: The NLF was divided into 3 parts: the lateral folded part (LFP), medial depressed part (MDP), and central creased part (CCP). Between November and December 2021, 14 patients underwent the combination treatment; of these, 11 were enrolled, excluding 3 who were not properly followed up. On average, 5.82±0.87 (right) and 5.73±0.47 (left) PDO mesh threads (6.0 cm length) were sequentially inserted into the LFP, MDP, and under the CCP of each NLF. Following this, an average of 1.82±0.71 ml (right) and 1.92±0.75 ml (left) of the filler was also sequentially injected into each NLF in a similar manner. They were mainly placed in the superficial and deep fat layers in the entire NLF and sub-malar areas. Smile index was measured during the fully expanded smile stage. The follow-up period was 3 months. The results were estimated using pre- and post-operative photographs.
Results: Three months after the combination treatment, patients were pleased with the softening of their NLF. As indicated by the increased smile index (inter-commissural width/inter-labial gap), the old and expanded smile changed to younger and less expanded smile. The original smile type (eight and three patients with the commissure and cuspid types, respectively) remained unchanged. The contour changes in each smile varied according to the smile type. This could be explained by combination treatment’s NLF correction, which restricts facial expression muscle movement.
Conclusion: These results demonstrate definite evidence of softening of the NLF, a youthful smile, and an increased smile index.

Keywords: hyaluronic acid filler, nasolabial fold, polydioxanone thread, smile change, smile index

Fig. 1.Measurement of the parameters of the frontal smile. The inter-commissural width (A) and inter-labial gap (B) of the patients were measured for the analysis of the smile index on Adobe Photoshop.
  1. Rubin LR, Mishriki Y, Lee G. Anatomy of the nasolabial fold: the keystone of the smiling mechanism. Plast Reconstr Surg 1989;83:1-10.
    Pubmed CrossRef
  2. Kang KJ, Choung H, Hwang U. Correction of nasolabial fold by combination of polydioxanone thread and hyaluronic acid filler: a case report. J Cosmet Med 2021;5:103-7.
    CrossRef
  3. de Maio M. Myomodulation with injectable fillers: an innovative approach to addressing facial muscle movement. Aesthetic Plast Surg 2018;42:798-814.
    Pubmed KoreaMed CrossRef
  4. Manjula WS, Sukumar MR, Kishorekumar S, Gnanashanmugam K, Mahalakshmi K. Smile: a review. J Pharm Bioallied Sci 2015;7(Suppl 1):S271-5.
    Pubmed KoreaMed CrossRef
  5. Grover N, Kapoor DN, Verma S, Bharadwaj P. Smile analysis in different facial patterns and its correlation with underlying hard tissues. Prog Orthod 2015;16:28.
    Pubmed KoreaMed CrossRef
  6. Ackerman MB, Ackerman JL. Smile analysis and design in the digital era. J Clin Orthod 2002;36:221-36.
  7. Kang KJ. Sequential autologous fat injection techniques for volumetric face lifting in young Korean females. J Cosmet Med 2020;4:57-63.
    CrossRef
  8. Jung GS. Hyaluronic acid filler injection technique in multiple layers of the nasolabial fold. Plast Reconstr Surg Glob Open 2020;8:e3318.
    Pubmed KoreaMed CrossRef
  9. Hur MS, O J, Yang HM, Kwon HJ, Lee S, Lim HS, et al. Heights and spatial relationships of the facial muscles acting on the nasolabial fold by dissection and three-dimensional microcomputed tomography. PLoS One 2020;15:e0237043.
    Pubmed KoreaMed CrossRef
  10. Philips E. The classification of smile patterns. J Can Dent Assoc 1999;65:252-4. Erratum in: J Can Dent Assoc 1999;65:324.

Article

Original Article

J Cosmet Med 2022; 6(2): 78-83

Published online December 31, 2022 https://doi.org/10.25056/JCM.2022.6.2.78

Copyright © Korean Society of Korean Cosmetic Surgery.

Changes in smile index after correction of deep nasolabial fold using a combination of polydioxanone thread and hyaluronic acid filler

Hana Kwon, MEd1 , Hyemin Oh, DDS2 , Hyunjee Chae, MD3 , Pattaraporn Thiangthae, MD4 , Kyoung-Jin Kang, MD, PhD5

1Pascal Korea Ltd., Seongnam, Rep. of Korea
2Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Rep. of Korea
3Masterpiece Plastic Surgery and Skin Hospital, Bangkok, Thailand
4Kluaynamthai Hospital Network Clinic, Bangkok, Thailand
5Shimmian Clinic, Seoul, Rep. of Korea

Correspondence to:Kyoung-Jin Kang
E-mail: safikccs@pascal-world.com

Received: November 23, 2022; Revised: December 5, 2022; Accepted: December 8, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Filler injections are commonly used to soften deep nasolabial folds (NLF) by restoring volume in the depressed parts of fold. Recently, a combination technique using hyaluronic acid filler and polydioxanone (PDO) thread significantly improves deep NLF and induced changes in smile.
Objective: This study retrospectively confirmed the effects of this combination therapy, focusing on smile changes.
Methods: The NLF was divided into 3 parts: the lateral folded part (LFP), medial depressed part (MDP), and central creased part (CCP). Between November and December 2021, 14 patients underwent the combination treatment; of these, 11 were enrolled, excluding 3 who were not properly followed up. On average, 5.82±0.87 (right) and 5.73±0.47 (left) PDO mesh threads (6.0 cm length) were sequentially inserted into the LFP, MDP, and under the CCP of each NLF. Following this, an average of 1.82±0.71 ml (right) and 1.92±0.75 ml (left) of the filler was also sequentially injected into each NLF in a similar manner. They were mainly placed in the superficial and deep fat layers in the entire NLF and sub-malar areas. Smile index was measured during the fully expanded smile stage. The follow-up period was 3 months. The results were estimated using pre- and post-operative photographs.
Results: Three months after the combination treatment, patients were pleased with the softening of their NLF. As indicated by the increased smile index (inter-commissural width/inter-labial gap), the old and expanded smile changed to younger and less expanded smile. The original smile type (eight and three patients with the commissure and cuspid types, respectively) remained unchanged. The contour changes in each smile varied according to the smile type. This could be explained by combination treatment’s NLF correction, which restricts facial expression muscle movement.
Conclusion: These results demonstrate definite evidence of softening of the NLF, a youthful smile, and an increased smile index.

Keywords: hyaluronic acid filler, nasolabial fold, polydioxanone thread, smile change, smile index

Fig 1.

Figure 1.Measurement of the parameters of the frontal smile. The inter-commissural width (A) and inter-labial gap (B) of the patients were measured for the analysis of the smile index on Adobe Photoshop.
Journal of Cosmetic Medicine 2022; 6: 78-83https://doi.org/10.25056/JCM.2022.6.2.78

References

  1. Rubin LR, Mishriki Y, Lee G. Anatomy of the nasolabial fold: the keystone of the smiling mechanism. Plast Reconstr Surg 1989;83:1-10.
    Pubmed CrossRef
  2. Kang KJ, Choung H, Hwang U. Correction of nasolabial fold by combination of polydioxanone thread and hyaluronic acid filler: a case report. J Cosmet Med 2021;5:103-7.
    CrossRef
  3. de Maio M. Myomodulation with injectable fillers: an innovative approach to addressing facial muscle movement. Aesthetic Plast Surg 2018;42:798-814.
    Pubmed KoreaMed CrossRef
  4. Manjula WS, Sukumar MR, Kishorekumar S, Gnanashanmugam K, Mahalakshmi K. Smile: a review. J Pharm Bioallied Sci 2015;7(Suppl 1):S271-5.
    Pubmed KoreaMed CrossRef
  5. Grover N, Kapoor DN, Verma S, Bharadwaj P. Smile analysis in different facial patterns and its correlation with underlying hard tissues. Prog Orthod 2015;16:28.
    Pubmed KoreaMed CrossRef
  6. Ackerman MB, Ackerman JL. Smile analysis and design in the digital era. J Clin Orthod 2002;36:221-36.
  7. Kang KJ. Sequential autologous fat injection techniques for volumetric face lifting in young Korean females. J Cosmet Med 2020;4:57-63.
    CrossRef
  8. Jung GS. Hyaluronic acid filler injection technique in multiple layers of the nasolabial fold. Plast Reconstr Surg Glob Open 2020;8:e3318.
    Pubmed KoreaMed CrossRef
  9. Hur MS, O J, Yang HM, Kwon HJ, Lee S, Lim HS, et al. Heights and spatial relationships of the facial muscles acting on the nasolabial fold by dissection and three-dimensional microcomputed tomography. PLoS One 2020;15:e0237043.
    Pubmed KoreaMed CrossRef
  10. Philips E. The classification of smile patterns. J Can Dent Assoc 1999;65:252-4. Erratum in: J Can Dent Assoc 1999;65:324.

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