Glossary of Facial Shadows | Newport Beach Plastic Surgeon Explains

Sometimes one of the greatest challenges of achieving aesthetic treatment is communicating your concerns, assuming your provider understands you, and assuring that you and your provider are on the same page. In fact, many patient complaints arise from the fact that they did not get what they were asking for, and that may originate from imperfect communication regarding their unique goals and desires. This may result from the inability of the patient to express his or her concerns, or just as likely, the practitioner from understanding the patient’s concerns, in his or her own words.

After seven years of plastic surgery-specific training, I still do not understand all the names for facial wrinkles, shadows, and folds. This is because there is no clear-cut unifying body or compendium of terminology for patients and practitioners. Hopefully, this video and blog, and this pictorial may scratch the surface of this issue. At least, it may make communication better between my own patients and practitioners. A great example of the inconsistency and facial terminology was when I did a good faith examination last year for my nurse, Joanna the Nurse. She consistently stated that she was treating the “smile lines”, and I wanted to know more specifically what these were. You mean nasolabial folds?

In my opinion, “smile lines” can represent any single wrinkle, fold, or change to the face when one smiles. They are Langer’s lines of relaxed skin tension. Therefore, every single wrinkle that occurs on the face (crow’s feet, glabellar furrows, marionette lines, nasolabial folds) are “smile lines”. Likely, nasolabial folds are the so-called smile lines, as the consensus is that smile lines arise from the base of the nose and terminate towards the corner of the mouth. However, due to the potential for a smile line to occur anywhere in the face, I think we need to be more specific as providers, and patients need to be more specific when they are presenting their primary concerns.

A quick Google study makes it very hard to identify consistencies in terminology and nomenclature of facial folds. I have therefore provided this primer, and a pictorial, to make things easier, and hopefully, to establish a standard in describing facial anatomy.

For the cheek, use the prefix melo- (from latin, melon) and suffix -jugal (cheek). The cheek is an anatomic unit that originates underneath the tear trough and terminates along the jawline.

For the lip, use the prefix labio- or the suffix -labial. Although the upper lip, in reconstructive terms, includes the skin between the nose and vermilion (pink), for aesthetic purposes, most people think of the lips as the vermilion only. However, a lip lift does not address the vermilion directly whatsoever.

For the nose, use a prefix naso- and the suffix -nasal. The nose originates along an imaginary line between the eyebrows and continues down to clear-cut junction at the upper lip (i.e., the nasolabial or columellar-labial angle).

For the chin, use the prefix mento- and the suffix -mental. The chin and lower lip intersect at a crease in some patients and a depression and others. The chin proper is an ovoid mass that is defined largely by its bony infrastructure.

Your decision to use prefixes or suffixes should be interchangeable, however, there are many traditional arrangements to consider. For example, the intersection of the nose and cheek is often called a nasojugal fold. However, “melonasal” is just is accurate. Incidentally, nobody uses that terminology and you would be better served calling it a nasojugal fold. For the same reason, the melolabial fold is also the “labiojugal” fold, but I have never heard anybody call it that. Finally, a fold originating at the corner of the mouth and ending at the chin is typically called “marionette lines” in my practice and elsewhere. However, the term “melomental” fold is just as accurate. Incidentally, mentolabial fold and labiomental folds are both used frequently in the literature.

Although my intention to clarify confusion in defining furrows, folds, creases and shadows on your face may have caused more confusion, hopefully this set of guidelines will allow you to communicate your set of concerns with your provider more effectively, and to establish a better course of communication that will make it easier for you to achieve your aesthetic goals.

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