Nasolabial folds, also sometimes referred to as "parentheses" is the term used to refer to the folds of skin that one sees running from the side of the nose to the corners of the mouth on each side. Normally just a mild depressed line or none at all in the young up to the age of 25 years, it starts to make its presence felt with age. With the effect of age and gravity, the cheek pads on both sides tend to become heavier and larger and drags down over the fold to try to reach the mouth, so to speak, and this results in deeper and more obvious nasolabial folds, evidence that the person is ageing, and making the person feel and look his or her age, or worse still, older than he or she actually is. The depth of the folds is accentuated by smiling and grinning.

Look at yourself in the mirror, which does not lie. Concentrate on your nasolabial folds. Are they deep? Put your fingers to the sides of your cheeks and pull gently backwards and slightly upwards to spread the cheeks apart. In doing so you open up the nasolabial folds. Notice how you look 10 years younger immediately. Men and women have, from time immemorial, tried their best to look younger than they actually are, in an effort to recapture the youth that faded away a bit too fast.

There are three major ways to reduce nasolabial folds. The first two are somewhat more traumatic and reserved for the much older person. These are facelifts and thread lifts, both designed to fight gravity by pulling the skin of the cheeks to the back.

The third, easier and more acceptable way is by using cosmetic fillers, and an ideal filler for the nasolabial folds is Juvaderm. Juvaderm (more correctly known as Juvederm) is a cross-linked hyaluronic acid gel -like filler, a biosysthesised completely safe compound that has been altered by cross-linkage to last up to one year in the human body after injection. Hyaluronic acid is a naturally occurring substance seen in the matrix of the dermis layer of the skin, and is very capable of absorbing water, adding to the natural volume of the skin. Juvaderm does not cause any allergy reaction by virtue of its very nature of being hyaluronic acid and not foreign material.

Injection of Juvaderm is normally done as a lunchtime procedure under local anesthetic, either from application of anesthetic creams or local injection of Xylocaine near a regional sensory nerve. The procedure of Juvaderm cosmetic filler injection is quite fast in skilled hands, taking usually less than 10 minutes with direct injection of Juvaderm into the dermal layer of skin in several smooth and unbroken lines till the fold gets filled up along the crease from the corner of the nose till it ends past the corner of the mouth.

After the injection of Juvaderm, the needle is withdrawn and the result is shaped to satisfaction by pressure with the fingers on the injected Juvaderm gel. The injected Juvaderm stays where it is after molding. A follow-up visit to the doctor is normally suggested in one week for re-assessment and topping up of Juvaderm if necessary to correct any left over defects. Juvaderm stays put up to one year, by which time the substance will have been completely absorbed and the nasolabial fold recurs. Normally the patient will have been so pleased with the result (don't forget, it's 10 years taken off your age!), that there is no hesitation in asking for a repeat Juvaderm injection!

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