FACIAL SUSPENSION AND RECONSTRUCTION OF THE NASOLABIAL FOLD WITH THE USE OF LOCAL DERMAL-FAT FLAP

Introduction: Facial nerve paralysis causes functional, cosmetic, and social dysfunctions. Patients experience changes in oral competence, eye protection, and verbal transmission capacity, impacting their relationships and social interactions (1). The affected side typically exhibits fewer wrinkles, drooping of the lip and eyebrow corners, and a less pronounced nasolabial fold (NLF) (2). Even after rehabilitation, asymmetry may persist in the labial commissure if the NLF is not reconstructed (3).

Several techniques have been developed to address the appearance and functional limitations of patients with permanent sequelae of facial nerve palsy. These include static treatment techniques, such as plication of the Musculo-Aponeurotic System (SMAS) and facial suspension with autogenous or allogeneic materials, as well as dynamic resuscitation techniques, such as cross-face nerve grafting with microsurgical gracilis flaps (4). In contrast, the proposed technique is simple, reproducible, and can be performed in an outpatient setting.
Objective: To detail a surgical technique for restoring the nasolabial fold in patients with chronic facial nerve paralysis.

Methods: This series of cases describes a new technique approved by the Ethics and Research Committee of the Federal University of São Paulo. It was performed on patients aged between 40 and 80 years old, with chronic facial paralysis who were not candidates for dynamic rehabilitation and had erasure of the NLF. The technique involved surgical marking based on NLF measurement, followed by local anesthesia and surgical procedures including de-epidermization and fixation of the NLF using a Casagrande needle. Evaluation criteria included photographic records and improvement in ipsilateral nostril breathing six months post-surgery.

Results: Four procedures were conducted without complications, resulting in improved facial symmetry, NLF restoration, elevation of the lip commissure, and correction of nasal deviation.

Discussion: The proposed technique offers simplicity, being performed under local anesthesia without the need for additional tissues or synthetic materials. It achieves discreet elevation of the nasal wing and improves aesthetics and respiratory function. While it is a simple technique with low morbidity, possible complications are lower than those associated with widely used complex techniques. However, other procedures may need to be combined to achieve symmetry and treat facial paralysis, such as fat grafting or rhytidoplasty.

Conclusion: The described static treatment technique provides a simple outpatient solution for restoring the NLF in chronic facial nerve paralysis.

References:
1- Neamonitou F, et al. Dynamic Surgical Restoration of Mid and Lower Facial Paralysis: A Single-Greek-Centre Experience. Cureus. 2024 Jan 16;16:e52387.
2- Van Veen MM, et al. Association of Regional Facial Dysfunction With Facial Palsy-Related Quality of Life. JAMA Facial Plast Surg. 2019 Jan 1;21(1):32-37.
3- Bhama PK, et al. Refinements in nasolabial fold reconstruction for facial paralysis. Laryngoscope. 2014 Dec;124(12):2687-92.
4- Zuo KJ, et al. Dynamic Reconstruction of Facial Paralysis in Craniofacial Microsomia. Plast Reconstr Surg. 2022 Apr 1;149(4):919-929.

Reconstructive

PSTM 2024