Which treatment is best for improving nasolabial folds? From causes to treatment selection

If you've started to worry about the deep lines flanking your mouth when you look in the mirror, here is the first thing you need to know. Nasolabial folds are not simple "skin wrinkles," but rather folds caused by the sagging and hollow appearance of the cheeks.

That's why the formula "fillers are a must for nasolabial folds" is half-right and half-wrong. If your nasolabial folds are caused by a loss of volume, fillers are close to the right answer, but if sagging is the cause, filling them only with fillers will make the area around your mouth look heavier. Identifying the cause first is the starting point for all treatment choices.

Table of Contents

• Nasolabial Folds, What Exactly is the Problem?

• Are My Folds Caused by Sagging or Lack of Volume?

• Comparison of Nasolabial Fold Treatments at a Glance

• Examining Treatments, From Fillers to Surgery

• Why Safety is Truly Important

• Realistic Treatment Sequence by Age Group

• Frequently Asked Questions

🔍 Nasolabial Folds, What Exactly is the Problem?

The medical term for nasolabial folds is **nasolabial fold**. They are the lines that run from the sides of the nose down toward the corners of the mouth. The important thing to know is that these are not "wrinkles" caused by continuous muscle movement in facial expressions, but rather "folds" caused by soft tissues sagging downward.

There is more than one cause. While the cheek fat layer of the midface shrinks and sags downward, bone absorption of areas like the maxilla, along with a decrease in collagen and elastic fibers, occurs simultaneously. On top of this, repetitive facial expressions, UV rays, smoking, genetics, and weight changes also contribute.

Therefore, the approach of "only filling the nasolabial line" has its limits. The areas that are truly sunken are the front cheeks and below the cheekbones. A natural result is achieved when the midface supporting structure is supported together rather than just the nasolabial fold itself.

📌 Key Summary: Nasolabial folds are a structural change that couples volume reduction + midface sagging + elasticity decline. Distinguishing the cause is a prerequisite for treatment selection.

🪞 Are My Folds Caused by Sagging or Lack of Volume?

There is a simple way to check at home. In front of a mirror, use your fingers to gently pull up the cheek fat below your cheekbones.

• If the folds become visibly lighter → It is closer to the sagging type. Lifting should come first.

• If there is little change → It is highly likely to be the lack of volume type. Volume-filling treatments are a priority.

Of course, most people have a combination of both. Therefore, for moderate cases or higher, a combined approach of lifting + volume replenishment + skin elasticity improvement is the standard rather than ending with a single treatment. The final precise judgment lies with the medical staff who visually inspect and touch the area, but knowing this much will elevate the quality of your consultation.

📌 Key Summary: If the folds decrease when you pull up the cheek fat, it is the sagging type; if not, it is the lack of volume type. For moderate cases or higher, a combined approach is fundamental.

📊 Comparison of Nasolabial Fold Treatments at a Glance

💉 Examining Treatments, From Fillers to Surgery

Filler — The Most Popular First Choice

Hyaluronic acid fillers are the top priority for nasolabial fold treatments due to their immediate volume effect and reversibility. A big advantage is that they can be dissolved with hyaluronidase if a problem arises. The duration is usually 6 to 18 months, depending on the product and individual metabolism. About 2cc in total for both sides (1cc per side) is a common standard.

However, if you put too much filler on a sagging-type face, the area around your mouth can appear protruding, making you look like a **'monkey'**. Filling it up does not make it more natural.

**Calcium Hydroxyapatite (CaHA, Radiesse)** stimulates collagen production in addition to immediate volume, so the results last longer. However, you must take into account that it cannot be dissolved.

Sculptra — Slowly, Naturally

Consisting of Poly-L-lactic acid (PLLA) ingredients, this is a method that stimulates your own collagen production. It slowly fills up from 4 to 6 weeks after the treatment and lasts for about 2 years. The '5-5-5 rule' to prevent nodules, which is massaging for 5 minutes, 5 times a day, for 5 days after the treatment, is recommended.

Thread Lifting — Directly Pulling the Sagging Skin

This treatment physically pulls up the skin with threads made of PDO, PLLA, PCL, etc., while also inducing collagen. It is suitable for nasolabial folds accompanied by sagging, and depending on the type and number of threads, it lasts 6 to 18 months. There is a common misconception that "the more threads you insert, the better," but putting in too many will make your expressions look unnatural and delay recovery.

Ultherapy · Thermage · Needle RF — Non-invasive Elasticity Improvement

Ultherapy (HIFU) is a representative non-invasive lifting treatment that stimulates the SMAS layer using ultrasound. Thermage contracts and regenerates dermal collagen with high frequency, and needle RF, such as InMode, directly stimulates the dermis with microneedles. All three show gradual effects over 1 to 3 months and last 6 to 12 months. It is realistic to see them as supporting roles to maintain elasticity rather than as standalone solutions to eliminate nasolabial folds.

Autologous Fat Grafting · Facelift · Noble Surgery — More Fundamental Solutions

Autologous fat grafting transfers your own fat to the midface, which has semi-permanent potential, but because the engraftment rate fluctuates between 30% and 70%, over-correction taking into account partial absorption is common.

For the middle-aged or elderly with severe sagging, a facelift is the most powerful option. The effect lasts for more than 5 to 10 years, but there are burdens of incision, recovery period, and scarring. Noble surgery is a method of inserting an implant into the sunken area next to the nose, providing a permanent solution for congenitally deep nasolabial folds, but there are risks of foreign body sensation and displacement.

For reference, Botulinum Toxin is not the mainstay of standalone treatment for nasolabial folds. Because nasolabial folds are not muscle wrinkles, but rather structural sagging issues. It is used only restrictively for auxiliary purposes such as correcting the depressor anguli oris muscle.

📌 Key Summary: Fillers, fat grafting, and Sculptra for lack of volume; threads, Ultherapy, and facelifts for sagging; high-frequency treatment for lost elasticity. Botox is not the mainstay.

⚠️ Why Safety is Truly Important

The nasolabial area is a place where the facial artery and the superior labial artery pass close by. Thus, if filler enters a blood vessel, vascular occlusion occurs, and skin necrosis or vision loss is rarely reported. Although it is not a common occurrence, it is a risk that should never be taken lightly.

Therefore, you should verify if an emergency response system, such as hyaluronidase, is in place. However, keep in mind that this medication cannot perfectly reverse all situations.

If any of the following signals appear after the treatment, you must contact the clinic immediately.

• The skin turning white or becoming mottled

• Blurry vision or change in sight

• Pain that worsens over time

Ultimately, the biggest variables that separate results and safety are the injector's anatomical understanding and proficiency. During your consultation, make sure to ask, "Is it a hyaluronic acid filler?" and "Is emergency response to vascular occlusion available?".

📌 Key Summary: Since nasolabial fillers carry risks of vascular complications, checking the emergency response system and medical staff's proficiency is essential.

🎯 Realistic Treatment Sequence by Age Group

The answer varies from person to person, but the flow is roughly as follows.

• Early 30s · Initials: Sagging is still mild. It is cost-effective to start with a small amount of filler or collagen-stimulating treatments and practice lifestyle management such as UV protection and tobacco cessation.

• 40s · Moderate: Sagging and volume loss occur together. A combined approach of supporting with thread lifting or Ultherapy first, and then finishing with fillers, looks natural.

• 50s and older · Severe sagging: Fillers have their limits. This is the stage to consider fundamental treatments like facelifts.

When combining treatments, the sequence of setting the foundation with lifting first and then filling volume is usually appropriate. However, the interval between treatments varies depending on the device and individual conditions, so coordinate with your medical staff.

One more thing. The realistic goal is not to completely eliminate nasolabial folds but to 'alleviate and improve' them. The folding that occurs when you smile is a normal anatomical structure. Trying to erase even that will make it look unnatural.

📌 Key Summary: Prevention and small amounts for the 30s, a combined approach for the 40s, and surgery consideration for those in their 50s and older. The goal is 'improvement', not 'removal'.

💬 Frequently Asked Questions

How can I tell if my nasolabial folds are due to sagging or lack of volume?

In front of a mirror, try pulling up your cheek fat with your fingers. If the folds lighten, it is closer to the sagging type; if there is no change, it is closer to the lack of volume type. However, for most people, both causes are mixed, so precise judgment requires a medical diagnosis.

Can Botox eliminate nasolabial folds?

It is difficult. This is because nasolabial folds are not muscular wrinkles, but are primarily caused by structural sagging and volume loss. Botox is used only restrictively for auxiliary purposes such as mouth corner correction.

Can I receive fillers and thread lifting at the same time?

It is possible. However, if there is sagging, the sequence of setting the foundation with lifting first and then filling volume looks natural. Whether to receive concurrent treatments and the intervals depends on individual conditions, so consult with your medical staff.

What should I do if my skin turns white after a nasolabial filler treatment?

This is an emergency situation as it can be a sign of vascular occlusion. If the skin becomes pale, pain worsens, or vision becomes blurry, you must contact the treating clinic immediately. Emergency treatment to dissolve the filler with hyaluronidase may be required.

Can nasolabial folds be completely eliminated?

Alleviating and improving them is a more realistic goal than complete removal. Nasolabial folds that occur when smiling are a normal anatomical structure, so erasing them excessively will make them look unnatural.