Nasolabial folds, or “smile lines,” are creases from the nose to the mouth caused by aging and fat loss. Treating them effectively requires more than just a quick fix—it demands choosing the right dermal filler tailored to the depth of the folds, skin type, and desired outcomes.
Choosing the right dermal filler for nasolabial folds —like HA for instant results or PLLA for long-term volume—means natural outcomes. The wrong one? It risks issues like overfilled cheeks creating a “pillow face,” product migration causing asymmetry, or lumpiness from overly firm fillers in delicate areas, which can be hard to fix.
Learn about top filler options, expert techniques, safety tips, and combination treatments to achieve the best results every time.
What Are Nasolabial Folds?
These creases are a natural part of facial anatomy but tend to become more prominent with age. Several factors contribute to this deepening, starting with the body’s natural decline in collagen and elastin production—two key proteins that keep the skin firm and elastic. As this support weakens, the skin begins to sag, making the folds more noticeable.
Additionally, fat in the midface diminishes and shifts downward over time, leaving the cheeks less full and causing the folds to appear deeper. External influences, like prolonged sun exposure or smoking, accelerate these changes by damaging the skin’s structure. To complicate matters further, bone loss in the midface reduces the foundation that supports soft tissue, leading to an overall loss of volume and definition.
Together, these factors result in folds that can make the face look tired or prematurely aged. Addressing nasolabial folds effectively requires understanding these underlying causes and using targeted treatments to restore a balanced and refreshed appearance.
How Dermal Fillers Work for Nasolabial Folds
Dermal fillers are a reliable solution for restoring volume, smoothing wrinkles, and enhancing facial contours, including temple, cheeks, and other parts of the face. When used to treat nasolabial folds, they address the underlying causes of these creases by lifting and supporting the tissue. By targeting specific layers of the skin, fillers soften the appearance of deep lines and restore facial balance.
The process begins with a thorough consultation to evaluate the patient’s facial structure and discuss their goals. This personalized approach ensures that the treatment plan aligns with the severity of the folds and the individual’s skin type, creating a tailored solution for optimal results.
Once the plan is established, the area is prepared with meticulous cleansing to ensure hygiene, and a numbing agent may be applied to enhance comfort. Precision during the injection process is essential. Using either a fine needle or a blunt-tip cannula, the filler is carefully placed at varying depths based on the treatment area’s needs. This targeted technique ensures even distribution and a natural-looking outcome.
After the procedure, patients may experience mild swelling or bruising, which typically resolves within a few days. The results become more apparent as these temporary effects subside, leaving the face refreshed and balanced. By addressing both volume loss and contour irregularities, dermal fillers effectively diminish the prominence of nasolabial folds while maintaining a natural, harmonious appearance.
Types of Dermal Fillers for Nasolabial Folds
Several types of fillers are available for treating nasolabial folds, each with distinct properties and applications.
Hyaluronic Acid (HA) Fillers
Hyaluronic acid fillers, such as Juvederm® and Restylane®, are widely used for their versatility and immediate results. HA is a naturally occurring substance in the skin that retains moisture and adds volume, making it ideal for mild to moderate folds. Juvederm® and Restylane® are reversible with hyaluronidase, providing flexibility in treatment.
- Duration: Results typically last 6–18 months, depending on the formulation and treatment area.
- Best For: Mild to moderate folds and patients seeking quick, adjustable outcomes.
Calcium Hydroxylapatite (CaHA) Fillers
CaHA fillers, like Radiesse®, contain calcium microspheres suspended in a gel. They provide immediate volume and stimulate collagen production over time, making them suitable for deeper folds requiring structural support.
- Duration: Effects last 12–18 months.
- Best For: Moderate to severe folds and individuals needing long-term correction.
Poly-L-Lactic Acid (PLLA) Fillers
PLLA fillers, such as Sculptra® (different from Radiesse®), work by stimulating the body’s natural collagen production. Unlike other fillers, PLLA doesn’t add immediate volume but offers gradual and long-lasting improvements.
- Duration: Results develop over weeks and can last up to two years with multiple sessions.
- Best For: Patients seeking subtle, progressive changes.
Polymethylmethacrylate (PMMA) Fillers
PMMA fillers, such as Bellafill®, are composed of biocompatible microspheres that provide permanent volume. These fillers are ideal for individuals with severe folds who desire long-term results.
- Duration: Permanent, though careful application is essential.
- Best For: Severe folds and patients seeking a durable solution.
Key Considerations When Choosing the Right Filler for Nasolabial Folds
The depth of the folds is one of the most important considerations. For shallow lines, fillers like hyaluronic acid (HA) work effectively to provide subtle volume and smoothness. In contrast, deeper creases may require denser options like calcium hydroxylapatite (CaHA) or poly-L-lactic acid (PLLA) to restore lost support and achieve a natural lift.
Skin type also plays a critical role. Individuals with delicate or thinner skin often respond better to fillers with a softer consistency, as these integrate more naturally with the surrounding tissue. On the other hand, firmer fillers are often necessary to address the structural needs of thicker skin, providing the robust foundation needed to reduce the appearance of prominent folds.
The expected results and timeline further guide the selection. HA fillers deliver instant improvements, making them ideal for patients seeking quick changes. Conversely, PLLA gradually stimulates collagen production, creating subtle, long-term enhancements. For those with severe folds and a preference for durable outcomes, polymethylmethacrylate (PMMA) fillers offer a permanent solution, provided the treatment is carefully planned and executed.
When considering filler options, flexibility and commitment are important. HA fillers, being reversible, are often preferred by individuals exploring injectable treatments for the first time. Non-reversible fillers, though longer-lasting, require thorough consultation and careful planning to ensure patient satisfaction.
Above all, safety is paramount. Opting for FDA-approved fillers and working with an experienced practitioner ensures that treatments are not only effective but also conducted with the highest standards of care.
Advanced Techniques for Treating Nasolabial Folds
The success of dermal filler treatments relies heavily on the injector’s technique, which must be both precise and adaptable to the patient’s unique anatomy. While the product used is important, the method of application often determines whether the results look natural and complications are minimized.
Linear threading is a commonly used technique where filler is injected along the length of the nasolabial fold. This approach creates a smooth, subtle contour that blends seamlessly with the surrounding tissue. For deeper creases, cross-hatching offers an alternative, forming a supportive grid beneath the skin to restore volume and reduce the appearance of pronounced folds.
In areas requiring extra care, such as regions near blood vessels, the cannula technique is particularly effective. Using a blunt-tip cannula helps minimize trauma to the skin and underlying structures, reducing the likelihood of bruising or vascular complications. This method also allows for precise placement of filler, ensuring consistent and safe results.
Combining different filler types and depths can further enhance the outcome. For example:
- Hyaluronic acid fillers are ideal for correcting fine surface-level lines.
- Calcium hydroxylapatite can rebuild deeper foundational support.
- A layered approach addresses both superficial and structural issues for a comprehensive improvement.
By tailoring the technique to the patient’s specific needs, these advanced methods not only reduce the prominence of nasolabial folds but also ensure a natural and harmonious enhancement.
Enhancing Results with Combination Therapies
While dermal fillers are highly effective, combining them with complementary treatments can optimize results. Neuromodulators, such as Botox, relax dynamic wrinkles around the mouth, reducing strain on the nasolabial folds. Skin resurfacing treatments, like laser therapy or microneedling, improve skin texture and elasticity, further enhancing the effects of fillers. Thread lifts offer a non-surgical way to reposition sagging skin, addressing the folds more comprehensively.
Preparing Patients for Treatment
Patient education is crucial for achieving the best outcomes. Patients should be informed about the procedure, expected results, and post-treatment care. Setting realistic expectations is vital, as fillers can significantly soften folds but may not eliminate them entirely.
Post-Treatment Care
- Avoid strenuous activities and sun exposure for 24–48 hours.
- Apply cold compresses to reduce swelling.
- Follow the practitioner’s aftercare instructions for optimal results.
Tips for Long-Lasting Results
To maximize the longevity of dermal filler results, patients should:
- Maintain Skin Hydration: Hyaluronic acid fillers, in particular, retain water. Drinking sufficient water and using HA-based topical products can enhance effects.
- Avoid Excessive Sun Exposure: UV radiation breaks down collagen and elastin, reducing filler efficacy.
- Regular Maintenance Treatments: Schedule touch-ups based on the filler’s expected duration to maintain consistent results.
How to Assess Nasolabial Folds for Treatment
Every patient requires an individualized treatment plan. The following steps guide professionals in assessing nasolabial folds:
- Facial Symmetry Analysis: Determine if one side of the face has deeper folds, which is common due to sleeping positions or dominant facial expressions.
- Severity Grading: Use scales like the Merz Nasolabial Fold Severity Scale (NLFSS) to classify folds from mild to severe. This ensures consistent treatment planning and measurable outcomes.
- Dynamic vs. Static Folds: Assess whether the folds are caused by dynamic movements (e.g., smiling) or static factors (e.g., aging and volume loss). Dynamic folds may require adjunctive treatments like botulinum toxin.
Future Trends in Dermal Filler Technology
The field of dermal fillers is rapidly advancing, with new innovations improving safety and efficacy. Hybrid fillers, combining hyaluronic acid with collagen-stimulating compounds, offer both immediate and long-term benefits. Advances in nanotechnology are enhancing filler integration, creating smoother and more natural-looking results. Additionally, 3D facial mapping technology allows for personalized treatments tailored to individual anatomy.
Potential Complications and How to Mitigate Them
Although dermal fillers are generally safe, complications can arise if proper protocols are not followed. Common issues include swelling and bruising, which can be minimized with precise injection techniques and appropriate post-treatment care.
Lumps and nodules may result from improper injection depth, but they are typically resolved through gentle massage or dissolving the filler with hyaluronidase. More serious complications, such as vascular occlusion—where filler enters a blood vessel and risks tissue damage—require immediate intervention using hyaluronidase.
To mitigate these risks, practitioners should employ aspiration techniques to confirm safe placement and use blunt-tip cannulas in high-risk areas to enhance safety.
Educating Patients: Questions to Ask During Consultations
Patients should be empowered to make informed decisions by asking:
- “Which filler is best suited for my skin type and goals?”
- “What are the potential risks, and how are complications managed?”
- “How many syringes will I need for optimal results?”
- “What can I expect during recovery?”
Conclusion:
Selecting the right dermal filler for nasolabial folds is a nuanced process that requires careful consideration of the patient’s anatomy, goals, and lifestyle. From immediate results with HA fillers to long-term improvements with PLLA or PMMA, there is a solution for every need. However, the success of the treatment ultimately depends on the expertise of the practitioner and the techniques used.
By understanding the science behind nasolabial folds and the options available, patients can make informed decisions and achieve natural, satisfying results. For those considering this treatment, consulting with a certified professional ensures both safety and success in restoring a youthful, refreshed appearance.
References
Lheritier C, Converset S, Rzany BJ, Cartier H, Ascher B. Efficacy of a New Hyaluronic Acid Dermal Filler on Nasolabial Folds Correction: A Prospective, Comparative, Double-Blinded Clinical Trial. Dermatol Surg. 2024 Aug 1;50(8):746-751. doi: 10.1097/DSS.0000000000004207. Epub 2024 May 7. PMID: 38713883; PMCID: PMC11288387.
Lupo MP, Smith SR, Thomas JA, Murphy DK, Beddingfield FC III,. Effectiveness of Juvéderm Ultra Plus dermal filler in the treatment of severe nasolabial folds. Plast Reconstr Surg. 2008 Jan;121(1):289-297. doi: 10.1097/01.prs.0000294968.76862.83. PMID: 18176233.
Li D, Sun J, Wu S. A multi-center comparative efficacy and safety study of two different hyaluronic acid fillers for treatment of nasolabial folds in a Chinese population. J Cosmet Dermatol. 2019 Jun;18(3):755-761. doi: 10.1111/jocd.12916. Epub 2019 May 10. PMID: 31074161.
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