Deep nasolabial folds (NLFs) are a common concern among aging patients. Hyaluronic acid (HA) filler is the first treatment choice. However, migration, spread to the surrounding space, and unnatural contours with lateral bulges occur frequently. Polydioxanone (PDO) thread has also been used by insertion of cogged PDO threads in the midface and the fold. Unfortunately, lifting lasts for only a few weeks. In the present case, a combination procedure using HA filler and PDO thread in the shape of the mesh tube was performed to improve the deep NLF in a 67-year-old woman. The intention of this combination was to unfold the NLFs and restore their volume without lateral migration of the injected filler. NLFs were divided into three parts: the lateral folded part (LFP), medial depressed part (MDP), and central crease part (CCP). Five PDO threads (6.0 cm length) were sequentially inserted into the LFP, MDP, and then under the CCP of each NLF. Total 4.0 ml of the filler was also sequentially injected into the both NLFs in a manner similar to the mesh thread insertion. They were mainly placed at the subdermal and superficial fat layer in the entire NLF and at the submuscular layer in the regions of the lateral part of the NLF, mouth corners, and submalar area. Three months after PDO thread insertion and HA filler injection, softened NLFs without filler migration, restored volume and lifted midface with a natural and charming smile, and reduction of perioral wrinkles were observed. These changes could be explained by the suppression of laughter movement accompanied by myo-modulation and increased firmness of the NLFs by the restoration of midface volume. These results suggest that the combination of PDO insertion and HA injection may be useful for correction of NLF.

Keywords: hyaluronic acid filler, mesh tube type, myo-modulation, nasolabial fold, polydioxanone thread

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