Smooth face structure always conveys a younger and energetic look. In the past, in order to restructure bone areas near the nasolabial folds, the accepted procedures were either repeated injection of hyaluronic acid into nasolabial fold area, or a wide-ranged osteotomy operation. Recently, flattening or removing the nasolabial sulcus has become a popular procedure in Korea. Locally, this is called the “Royal Surgery.” The author is not really sure why they have given it such a nickname, but the main idea is to fill up the inverted triangular dents located on either side between the outer edges of the nostrils and lips. As a result of this surgery, the face is smoother, not only making it look less unfriendly and serious, but also giving it an elegant and younger image.

Before having the procedure, it is important to know where the nasolabial sulcus is located. It is an inverted triangular dent located on either side between the outer edges of the nostrils and lips. It is caused by a congenital or inherited problem in which there is a gap between the zygomatic bone and maxilla. Some younger people might have noticeable nasolabial sulcus, and some might have combination problems with mid-face underdevelopment or maxillofacial snaggleteeth. This can be corrected as needed. People often think nasolabial sulcus is the same as nasolabial folds. In fact, folds are formed by aging or drooping tissues, and they start where the nasolabial sulcus are. On the other hand, people who have deep nasolabial sulcus will have nasolabial folds that occur early or their existing folds may deepen. The occurrence of nasolabial folds can be prevented, or existing folds can be improved by filling up the nasolabial sulcus. No wonder such procedure for middle-aged women in Korea is all the rage.
People might not be able to distinguish the difference between nasolabial folds and nasolabial sulcus. That results in spending too much money on hyaluronic acid injection without getting any significant improvement. According to the author’s experience, it is more pleasant and easier to inject hyaluronic acid for nasolabial fold improvement, but it might not be cost effective to use this procedure on nasolabial sulcus, because the dent of nasolabial sulcus is caused by an internal bone structure problem. Definitely, not much improvement will be evident, as hyaluronic acid treatment only affects the dermis layer—not deep enough to fix a bone problem. The only solution for nasolabial sulcus is to insert an artificial implant material to fill the dent. Surgery can be performed with an incision of approximately 1 cm on the upper gum, close to upper lip area. The whole procedure takes about 40 minutes and can be done with intravenous sedation. It takes 3-5 days for detumescence before returning to work. The surgery is the most effective treatment for an instant result.

There are three choices of artificial fillings:

1. Silicone Gel Cartilage
This material was used for a while when the filling method first started. Advantages include ease of insertion and short operation duration, but the cartilage may move or migrate. Therefore, it is being used less by surgeons.

2. Gore-Tex
Gore-Tex is inserted into the deeper skin layer, but not on top of bone. The shape and thickness of the material can be tailored to fit the individual condition. However, this material may result in having an unnatural smile and wider nostrils, as the material is inserted in the skin layer.

3. Medpor
The author thinks that this is the safest and most durable material. Its shape and size are highly ergonomic, because surgeons need to take a bit more time to make the perfect insertion. Its advantages are that it can be connected to the bone, it has less of a “foreign-object” feel, and it does not interfere with facial expression, because the material is inserted under the periosteum. The procedure also helps to correct partial mid-face sagging problems. A drawback is the high cost of the operation due to the procedure needed to insert bone nails to secure the material.

Any implant runs the risk of infection and this is true also for nasolabial sulcus filling surgery. According to the author’s experience, the risk can be zero if the surgeon has the professional skills to complete the procedure quickly. Also, a patient needs to consult with the doctor to choose a suitable size. If these conditions are met, the procedure should show remarkable results.