Nasolabial fold procedures: Why is 'where to fill' everything?

When contemplating treatments for nasolabial folds, the first thing to decide is not what procedure to receive. The proper sequence is to first understand 'why' your nasolabial folds formed. This is because nasolabial folds (medically referred to as the nasolabial fold, or non-surgical nasolabial aesthetic groove) are not simple skin wrinkles, but rather the complex, intertwined result of midface volume loss, cheek sagging, diminished collagen elasticity, facial muscles, and skeletal structures.

If the cause is different, the correct answer changes too. If the folds are caused by hollow cheeks, a volume-filling filler or collagen booster comes first; if they are caused by sagging cheek flesh, a lifting procedure to pull up the tissue is the priority. If you skip this diagnosis and blindly inject filler first, your face is highly likely to look heavy and unnatural. Let's gradually explain below how Gangnam Onlif Clinic approaches this from a dermatological, non-surgical treatment perspective.

🔍 Are My Nasolabial Folds Due to Hollowness or Sagging?

There is a simple self-assessment method you can try at home. Look in the mirror and slowly lie down. If your nasolabial folds soften or disappear when you lie down, loss of volume and sagging are the primary causes. If the folds remain even when lying down, fixed static wrinkles make up a large portion.

The nasolabial area is one of the most active parts of the facial skin. It creases every time you make an expression, and as you age and lose collagen, that area is no longer replenished. It is also common for folds to become prominent due to volume loss from rapid weight loss.

For reference, nasolabial folds and marionette lines are different. Nasolabial folds are the lines that run from the sides of the nose to the corners of the mouth, while marionette lines run down from the corners of the mouth to the chin. Confusing the two can lead to treatments in the wrong areas, so make sure to distinguish and clarify them during your consultation.

📌 Key Summary: If the folds disappear when lying down, they are caused by volume loss and sagging; if they remain, they are static wrinkles. Diagnosing the cause is the starting point for choosing a treatment.

💉 Which Treatment is Right for Each Condition? (Comparison Table)

Treatments for nasolabial folds are broadly divided into volume-replenishing, lifting, and skin regeneration categories. The combination varies depending on your condition.

Hyaluronic Acid (HA) fillers are the most representative material for nasolabial folds. Their advantage is immediate volume effect, and they have 'reversibility,' meaning they can be dissolved with an enzyme called hyaluronidase if any issue arises. The duration of the effect is roughly 6 to 18 months, depending on the product, injection layer, and individual metabolism. The initial treatment dosage is usually around 1 to 3 cc combined for both sides, but it varies depending on depth and structure.

Thread lifting (PDO, PLLA, PCL) physically pulls up saggy cheek tissue to indirectly improve nasolabial folds. Although the dissolvable threads are absorbed within several months, the lifting effect, which includes collagen production, lasts for about 1 to 2 years. HIFU (High-Intensity Focused Ultrasound) delivers thermal energy to the SMAS layer to induce lifting and collagen regeneration, with effects appearing gradually over 2 to 3 months post-treatment. Radiofrequency (RF) refers to tightening devices that contract and regenerate dermal collagen.

At Onlif, we design this combination through dermatology-focused, non-surgical procedures such as All-Tight Lifting, thread lifting, skin boosters, and ultrasound/radiofrequency. Rather than altering the shape of the eyes, nose, or mouth, the focus is on naturally restoring the balance and volume collapsed by aging.

📌 Key Summary: Volume for hollowness, lifting for sagging, and combined therapy for complex cases. Since non-surgical treatments are not permanent, periodic maintenance is required.

✨ Filling with Collagen — Onvolassom

If you feel burdened by fillers and worry about side effects, Onlif's Onvolassom is worth paying attention to. Onvolassom is a calcium mineral (CaHA)-based collagen booster specialized for nasolabial folds, targeting both volume replenishment and collagen regeneration, unlike typical HA fillers that simply fill the space.

The principle is as follows. Calcium particles with a unique lattice-pore structure adhere tightly and securely to the hollow area to immediately support volume, and subsequently decompose gradually to release calcium ions, thereby activating fibroblasts. As a result, self-collagen is produced, filling the skin's texture from the inside out. It aims for both immediate effects and long-term improvement.

The procedure consists of consultation & design → applying anesthetic cream → injection & correction → finishing, taking about 10 to 15 minutes in total. Since it contains lidocaine, the pain burden is relatively low, and most patients can return to daily activities immediately after the procedure. However, mild bruising or swelling may occur, so it is recommended to reduce irritation to the treated area for about a week.

It is particularly suitable for those whose nasolabial folds are vivid even when not smiling, those who look older due to nasolabial folds, and those who want natural and long-lasting changes. If sagging is present as well, it is often combined with thread lifting to enhance the final outcome.

📌 Key Summary: Onvolassom is a calcium collagen booster that 'fills instantly, regenerates long-term.' It is suitable for those who feel burdened by fillers or want to address skin elasticity as well.

🧭 Why We Restore 'Midface Volume' Instead of Using Fillers

In the past, directly filling the nasolabial groove with filler was a common method. However, things are different today. Over-injecting filler only into the nasolabial folds can easily make your expression look unnatural and heavy when smiling, so an approach that indirectly alleviates the nasolabial folds by reinforcing the midface volume of the front cheekbones and upper cheeks is highly preferred.

It makes perfect sense when you think about it. Nasolabial folds are crease marks caused by cheeks hollowing out and sagging, so if you only fill the groove without addressing the upper cheeks, which is the root cause, the fundamental issue remains. Supporting the upper part slightly causes the nasolabial groove itself to flatten naturally.

Autologous fat grafting, which utilizes your own tissue, is also used to reinforce midface volume, but its engraftment rate ranges roughly from 30% to 70%, making it difficult to predict and leaving a possibility of revision surgeries. Collagen-stimulating ingredients like PLLA (Sculptra) or CaHA (Radiesse), as well as PN/PDRN skin boosters that help regenerate skin, also serve as options for improving elasticity.

📌 Key Summary: Boosting midface volume is more natural than directly injecting into the nasolabial groove. Supporting the area of the cause yields long-lasting results.

⚠️ Safety, Make Sure You Know This

The reason nasolabial fillers can be scary is due to some rare but serious side effects. The facial artery and angular artery pass through the nasolabial area, and if filler is accidentally injected into a blood vessel, vascular embolization can occur, which can lead to skin necrosis or even blindness.

Therefore, the practitioner's anatomical knowledge and the availability of hyaluronidase (the enzyme that dissolves HA fillers) are critical. While using a cannula (a blunt-tip needle) reduces the risk, it does not reduce it to zero. There must be no misunderstanding on this point.

If any of the following symptoms occur, you must visit the clinic immediately:

• The skin turns pale, gray, or purple

• Severe, intolerable pain

• Blurred vision or abnormal visual symptoms

Also, as a rule, the procedure is not recommended for those who are pregnant/breastfeeding, have active skin infections, or are taking anticoagulants/immunosuppressants, so please make sure to disclose this during your consultation. During the consultation, you may directly ask, "Do you have hyaluronidase on hand?" and "Do you have a protocol for responding to vascular occlusion?"

What about Botox? When the main cause of nasolabial folds is volume loss or sagging, the effect of Botox alone is limited, and if used incorrectly, it can make your facial expressions look awkward. It is practical to utilize it only to assist in correcting drooping corners of the mouth.

📌 Key Summary: Vascular embolization is rare but fatal. Having hyaluronidase on hand, the medical staff's anatomical expertise, and seeking immediate medical attention upon abnormal symptoms are the keys to safety.

🏥 Is Surgery the Answer? Onlif's Perspective

In cases of severe cheek sagging, there are limits to what non-surgical treatments can do, and it is true that surgery like a facelift (SMAS lift) that physically pulls and excises the fascial layer yields the most permanent corrective effect. However, it carries significant burdens regarding anesthesia, incisions, and recovery.

Onlif prioritizes natural improvement through non-surgical procedures from a dermatological standpoint, rather than invasive incision surgeries. By combining lifting and volume, many nasolabial fold concerns can be managed without the burden of recovery. In line with the philosophy, 'Because you are precious, we do not change you,' the approach is not about changing your appearance, but restoring the innate beauty and balance obscured by aging.

Since a single doctor cannot master everything, Onlif proceeds carefully by assigning specific treatments to the practitioners who excel at them in their respective fields.

📌 Key Summary: While surgery may be the fundamental solution for extreme sagging, Onlif prioritizes natural improvements through non-surgical treatments that carry less recovery burden.

❓ Frequently Asked Questions (FAQ)

Between filler and lifting, which should I get first for nasolabial folds?

It depends on the cause. If the nasolabial folds are caused by hollow cheeks, a volume-filling filler or collagen booster comes first; if they are caused by sagging cheeks, lifting comes first. You can perform a rough self-assessment by seeing if the folds disappear when lying down, so make sure to get an accurate assessment during consultation.

How many cc's of filler are appropriate for nasolabial folds?

Typically, about 1 to 3 cc combined for both sides is common for initial procedures, but it varies depending on the depth of the lines and your facial structure. Over-injecting can actually result in an unnatural and heavy impression, so it is important to stick to an appropriate amount.

How long does the effect of nasolabial fold filler last?

Hyaluronic acid fillers last roughly 6 to 18 months, depending on the product, injection layer, and individual metabolism. Calcium collagen boosters like Onvolassom tend to last for 6 months to over a year, including the collagen regeneration effect.

Are there absolutely no vascular side effects if the treatment is performed with a cannula?

No. While a cannula reduces the risk of blood vessel damage, it does not reduce it to zero. The practitioner's anatomical expertise and the availability of hyaluronidase remain crucial.

Can Botox get rid of nasolabial folds?

If the main cause of the nasolabial folds is volume loss or sagging, the effect of Botox alone is limited. Using it incorrectly can make your facial expressions look awkward, so it is practical to use it for limited purposes, such as assisting in correcting drooping corners of the mouth.

Will my face look strange if I keep receiving filler injections?

Repeated treatments can cause filler to accumulate excessively, leading to potential migration or tissue distortion. It is best to plan retreatment with a safe interval of at least 6 months, taking your previous treatment history into account.

Can I receive Onvolassom even if I have already received filler treatments?

Yes, it is possible. However, the treatment plan may vary depending on your previous treatment history and current skin condition, so it is recommended to get an accurate evaluation during an in-person consultation.

What should I do if I suddenly lose my vision during the procedure?

Vision abnormalities, severe pain, and pale or discolored skin are emergency signals that can indicate vascular embolization. You must immediately inform the practitioner and receive emergency care, which is why it is vital to undergo procedures at a clinic equipped with hyaluronidase and an emergency response system.