Nasolabial Folds: Is Dermal Filler the Answer?

For the sagging type, lifting treatments that pull up tissue and enhance elasticity are considered first; for the volume-loss type, volume treatments that fill in sunken areas are given priority. Even for the same nasolabial folds, the approach order differs if the cause is different.

In practice, the two types are often mixed, so during a consultation, the degree of cheek sagging and volume status are assessed together to determine the priority. Since results can vary significantly with the same budget and number of sessions depending on the type, an accurate diagnosis is the first step.

Excessive dermal filler can prevent the tissue from moving naturally during facial expressions and make the mouth area appear puffy. The nasolabial area is a dynamic area that moves continuously when talking and smiling, so if filled based only on a static state, awkwardness in expressions can become apparent.

Also, if the cause is sagging cheeks and filler is repeatedly injected only into the crease, the sagging tissue and filled tissue can overlap, creating an impression of a heavy mouth area. The issue is not that dermal filler is inherently bad, but that the location and amount of injection do not match the cause.

Therefore, recently, rather than directly filling the crease, the preferred approach is to first replenish volume in the sunken upper part of the mid-face to support the tissue and then supplement the nasolabial crease with only a small amount as needed. Judgment of the appropriate amount and injection layer varies depending on an individual's facial structure, so evaluation by a board-certified dermatologist is important.

Thread lifting is considered when sagging is pronounced, and collagen injections are considered when you want to gradually restore skin elasticity and volume. Thread lifting uses dissolvable threads inserted to physically lift sagging tissue; its effect is relatively quickly visible, but the duration of results is generally known to be about one year.

Collagen induction injections do not directly create volume with the component itself, but stimulate the production of your own collagen within the skin, leading to improved elasticity and volume over several months. Sculptra (PLLA) and JUVELOOK Volume are examples, and their advantage is natural-looking volume that appears gradually.

Both methods have a different role from procedures that provide immediate volume like dermal filler, so the choice depends on the degree of sagging, skin thickness, and desired speed of change. It is safe to decide on the appropriate combination through a consultation.

A combined approach is necessary when both sagging cheeks and volume loss have progressed together, which is the case for most nasolabial folds after the age of 40. Because aging occurs simultaneously in multiple layers—skin, fat, fascia, and bone—it is difficult to reverse changes in all layers with a single treatment.

For example, if sagging is pronounced, a step-by-step plan could be: first tighten the fascial layer and skin elasticity with Ultherapy PRIME® or Thermage® FLX, then replenish sunken volume with HA Filler or Sculptra, and manage remaining fine lines and skin texture with other Skin Boosters. Adjusting the interval and order between treatments can also reduce recovery burden.

Nasolabial folds are a representative area where diagnosis of the cause determines the outcome. There are certainly cases where dermal filler is the answer, but we recommend confirming where the cause of your nasolabial folds lies through a consultation with a board-certified dermatologist before making a plan.