Complete Guide to Nasolabial Fold Fillers
— From the Causes of Deepening Nasolabial Folds to Filler Design Strategies and Duration
Nasolabial folds are lines that extend from the sides of the nose down towards the corners of the mouth, consistently ranking as the number one aesthetic concern in Korea and a representative sign of aging. However, simply understanding nasolabial folds as "wrinkles" can lead to an incorrect treatment approach. This is because nasolabial folds are not merely wrinkles, but rather three-dimensional changes that occur as the facial structure collapses.
This column details the medical causes of nasolabial folds, the principles of improvement through fillers, design strategies, and clinical considerations for effective treatment.
1. Anatomical Causes of Nasolabial Fold Formation
Nasolabial folds are not caused by a single factor but are formed by the complex interplay of multi-layered structural changes.
① Descent of the malar fat pad
The malar fat pad, which was positioned high on the cheekbones in youth, descends due to aging and gravity, compressing the perinasal border and making the nasolabial folds more prominent. This precisely matches the sensation patients often describe as "flesh sagging downwards."
② Relaxation of retaining ligaments
As the retaining ligaments that anchor facial skin to the bone loosen with age, the skin and fat tissue become prone to sagging. This creates and deepens a groove along the nasolabial crease.
③ Volume loss in bone and soft tissue
As the volume of the maxilla and the fat layer beneath the cheekbones decreases, the very structures supporting the skin collapse. This leads not only to a deepening of the nasolabial area but also to a general hollowing of the entire midface.
④ Dynamic factors due to muscle activity
Repeated contraction of perioral muscles (such as the orbicularis oris, zygomaticus major, etc.) can lead to habitual skin folding. Nasolabial lines may form at an earlier age, especially in individuals who smile frequently or have expressive faces.
2. Principles of Nasolabial Fold Fillers — Structural Restoration, Not Simple Filling
Nasolabial fold fillers aim not merely to fill in wrinkles but to three-dimensionally reconstruct the collapsed midface structure.
Treatment approaches generally follow two directions:
① Direct filling
This method involves injecting filler directly into the nasolabial crease (towards the nose) to lift the groove. While it provides immediate improvement, excessive injection without addressing the underlying structural causes can result in an unnatural "sausage shape" or convex protrusion.
② Structural support
This method involves restoring volume not directly beneath the nasolabial fold, but in the sunken malar fat pad and the sub-zygomatic space. This creates an effect where the entire cheek is lifted, and the nasolabial fold naturally becomes shallower. It is a preferred method among experienced practitioners due to its lower risk of side effects and ability to create natural results.
In clinical practice, these two approaches are combined and applied according to the patient's anatomical structure and aging pattern.
3. Nasolabial Filler Design Strategy — A Whole-Face Approach
Evaluating the overall facial volume distribution and supporting structures, rather than focusing solely on nasolabial folds, is key to achieving good results.
Midface volume first, direct nasolabial injection as an adjunct
The most common mistake in nasolabial fold treatment is focusing solely on the crease itself. It is far more natural and safer to first restore the hollowing in the mid-cheek and sub-zygomatic area, which is the true cause, and then subtly add direct filler to any remaining nasolabial lines.
Asymmetry correction
Most faces have left-right asymmetry. Nasolabial folds are often deeper on one side, so before treatment, the depth, direction, and cause of the wrinkles are analyzed from both side and front views to balance both sides.
Age-specific approach differences
Nasolabial folds in individuals in their early 30s are often primarily due to habitual expressions and can be improved with a relatively small amount of direct filling. For those in their 40s and 50s and beyond, overall cheek volume loss is the main cause, requiring structural support over a broader area. For individuals aged 60 and above, combining with lifting procedures is also considered.
4. Products Used for Nasolabial Fillers — Material Properties and Suitability
The nasolabial area is highly active with facial expressions and involves repeated skin folding, making filler selection extremely important.
Balance of viscoelasticity and elasticity (G')
For the nasolabial area, a hyaluronic acid filler with moderate elasticity and appropriate flexibility is more suitable than one that is too firm. A firm filler can cause a foreign body sensation during expressions, clumping, or contour deformation.
Products with high cohesivity
Products with high cohesivity, which disperse less and remain stably in the desired location, are advantageous for nasolabial treatment. Less spreading allows for precise design maintenance.
Hyaluronic acid vs. collagen-stimulating filler selection
Collagen-stimulating fillers (such as polylactic acid or calcium hydroxylapatite-based products) carry a risk of excessive tissue expansion or nodule formation when used in the nasolabial area, thus hyaluronic acid fillers are primarily recommended.
5. Injection Depth and Anatomical Precautions
The nasolabial area is a high-risk region where anatomical understanding is crucial due to the dense concentration of blood vessels, including the superior labial artery, angular artery, and facial artery.
Reasons for high vascular risk
The facial artery runs along the inner aspect of the nasolabial fold, exhibiting significant individual variations in this area. Intravascular injection can lead to serious side effects such as skin necrosis or blindness, making treatment at a verified medical institution crucial.
Principles of safe injection
- Reduced risk of vascular damage by using a blunt cannula
- Inject slowly in small amounts, checking for resistance
- Habitual aspiration before injection
- Immediate observation of blood flow and skin color after injection
6. Procedures That Can Be Combined with Nasolabial Fold Fillers
While nasolabial folds can be significantly improved with standalone filler treatment, combining procedures can maximize results, especially when the causes are complex.
Combination with Botox
In cases where dynamic nasolabial lines are severe due to excessive activation of perioral muscles, combining with a small amount of Botox can reduce the muscle activity that forms the lines, thereby enhancing the filler's duration and effectiveness.
Combination with lifting procedures
If cheek sagging is a primary cause, combining fillers with energy-based lifting procedures such as Shurink Universe or InMode Lifting can achieve a comprehensive effect of lifting the entire cheek while improving nasolabial folds.
Combination with skin boosters
If there is reduced skin elasticity or dryness in the nasolabial area itself, combining with skin boosters like Rejuran Healer or Skinvive can improve skin texture and enhance wrinkle reduction.
7. Nasolabial Filler Effects and Duration
The duration of nasolabial fillers varies depending on the product used, injection depth, individual metabolism, and intensity of facial expressions.
Generally, hyaluronic acid-based nasolabial fillers often show a duration of 6 to 12 months, with structural support fillers injected into the deep malar fat layer tending to last relatively longer.
In cases of repeated treatments, if additional filler is injected before the previous filler is completely absorbed, a cumulative collagen-stimulating effect can gradually occur, leading to natural skin improvement.
However, if the filler clumps or a foreign body sensation is felt, it is better to dissolve the previous filler with hyaluronidase first and then redesign, rather than adding more filler.
8. Nasolabial Fold Fillers are Particularly Effective for These Individuals
- Those with deep nasolabial folds accompanied by midface hollowing
- Those who have developed nasolabial lines due to sagging cheeks
- Those whose midface appears dark in photos
- Those who need additional volume correction after lifting procedures
- Those whose nasolabial lines are excessively emphasized when making facial expressions
Conversely, if nasolabial folds are primarily fine wrinkles of the skin itself, laser or skin booster treatments may be more suitable than fillers. This is determined through thorough consultation before the procedure.
BA Clinic's Approach to Nasolabial Fold Fillers
At BA Clinic, nasolabial folds are not viewed as isolated lines but rather as part of a comprehensive assessment of the entire midface's volume distribution and supporting structures. We prioritize a structural approach that first restores the sunken mid-cheek and sub-zygomatic space, and only then, if necessary, supplement with direct filling of the nasolabial lines.
After assessing the patient's face shape, aging pattern, skin thickness, and presence of previous fillers, a customized design is applied, with the director personally conducting 100% of the consultation and procedure.
If you are concerned about nasolabial folds, consult with BA Clinic to identify the exact cause and discuss a suitable treatment plan.
???? BA Clinic | Daejeon Dunsan-dong Dermatology Clinic
Operating Hours: Weekdays 10:00 ~ 20:00 / Weekends 10:00 ~ 16:00 (No lunch break)
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