Bunny Lines Nasolabial Folds
In this section, we will discuss how physicians are using advanced liquid face lift products, including dermal fillers, like Juvederm® Ultra, Radiesse® and Restylane®, as well as BOTOX®, for correction of wrinkle conditions on and around the nose. Along the upper third of the nose and nasal bridge, some individuals develop wrinkles that are commonly known as bunny lines. Bunny lines are a concern to many individuals. Another concern affecting just about everyone at one time or another is deepening of nasolabial folds. Nasolabial folds are lines or folds that run from the nose to the corners of the mouth.
Note: Before undergoing any procedure discussed on this web site, make sure that your physician has extensive experience with the specific procedure. Medical schools have only recently begun to teach some of these procedures. As with any medical procedure there are varying degrees of risk involved. Please consult your physician.
Bunny lines are wrinkles on the upper bridge of the nose or on either side of the nose that are caused by hyperactivity of nasalis muscles when smiling or laughing. They get the name bunny lines because they are formed from twitching the muscles of the nose. You can scrunch your nose to see bunny lines. These wrinkles may be horizontal, vertical or diagonal. Bunny lines are often superficial or shallow.
Physicians almost always treat bunny lines with a small amount of BOTOX® placed on either side of the nose, as well as in the transverse line that sometimes runs across the bridge of the nose. Experienced physicians will take care not to place the BOTOX® too lateral or away from the nose so as not to diminish or affect an individual’s smile. While only very small amounts of BOTOX® are used to treat bunny lines, individuals wishing to treat bunny lines will normally require regular small treatments as soon as they begin to reappear.
Advanced dermal fillers, such as Juvederm® or Restylane®, may also be used to treat bunny lines. Dermal fillers, when used, are placed under the skin beneath the lines to fill in a portion of the lines.
Nasolabial folds are deep creases or folds that run from the corners of the nose down to the corners of the mouth. Nasolabial folds vary in severity from lines to folds to crevasses, the latter being a very deep fold. In some instances, nasolabial folds arc around the corners of the mouth to form parentheses looking curves around the sides of the mouth. (See also: Mouth Area Wrinkles section) Nasolabial folds are usually a single crease, but can also be comprised of more than one line.
Nasolabial folds are an early sign of aging in many individuals. A variety of factors can contribute to the formation and severity of the folds. Over time, loss of facial collagen and elastin, as well as skeletal degradation and downward migration of the cheek pads can contribute to deepening folds. Exposure to environmental factors may also contribute to nasolabial folds. Individuals with more prominent, fatty cheek pads are predisposed to nasolabial folds, which may be noticeable even in youth.
Nasolabial folds may be treated with a variety of methods, depending upon the severity and type of fold. For the fine lines that look more like a stiletto cut, physicians will often place a filler superficially in the fold. If this technique is used, a less-bulking filler like Juvederm® Ultra will be used in very small amounts. Care must be taken by the physician to use small amounts of filler to avoid a Tindal effect, (a blue coloration visible through the skin). This is a very rare occurence with an experienced physician. Deeper nasolabial folds are typically treated by placing liquid face lift products, such as Juvederm® Ultra Plus, Perlane® or Radiesse® , more deeply underneath the fold. This technique will essentially push the fold up and alleviate the appearance of a fold, in some instances removing the fold entirely.
Most physicians will take care not to over treat the fold directly. Depending upon an individual’s unique facial characteristics, some subtle nasolabial depression may be a naturally desirable contour.
In addition to direct treatment of the nasolabial fold area, a liquid face lift procedure can have some additional positive effect on nasolabial folds. Lifting the upper face or adding volume to cheeks and other areas of the face will essentially pull back on the fold for an improved appearance. Therefore, a growing number of physicians also treat nasolabial folds by placement of liquid face lift products in other areas of the face such as the cheeks. For instance, some physicians will fill a hollowing mid-cheek and sub-malar area, which lifts the mound next to the nasolabial fold, partially effacing the nasolabial fold. Theses techniques are used more and more to help correct deeper nasolabial folds.
As with many of the procedures utilizing liquid face lift products, it is advisable to seek out a physician who has extensive experience with treatments involving liquid face lift products, including BOTOX® and advanced dermal fillers. The more experience a physician has, the more likely a physician will understand the critical subtleties of injection technique and placement to achieve natural contours given an individual’s unique facial characteristics.Contributing Physicians:
Laura E. Skellchock, MD, FAAD, Boca Raton, FL ~ Mark Berkowitz M.D. , Sterling Heights, MI
Arturo Guiloff MD, Palm Beach Gardens, FL ~ Mark A. Schusterman MD FACS, Houston, TX
Steven J. Pearlman MD FACS, New York, NY ~ Daniel Rousso MD FACS, Birmingham, AL
Leslie Gray M.D., Johns Creek, GA