Nasolabial Folds in Daegu — Is What Is Measured a Wrinkle, or a Shadow?

The conclusion, first

“Where in Daegu handles nasolabial folds well?” is a question that cannot be settled from public data. So we write a different answer instead — we set out what improvement in the nasolabial fold is measured with. There are three points. First, the nasolabial fold is not a wrinkle but a fold. The name of the widely used scale is the “wrinkle severity scale,” but the five-point scale that validated it afresh (73 subjects · three board-certified raters) states its object of measurement as “the presence of a depression and a shadow.” Second, three-dimensional measurement supports this — in a study comparing the grade against the three-dimensional grey value in 100 healthy people, the correlation coefficient was 0.985. Third, the original agreement of that scale is at the level of two thirds — in the original validation in the 1990s, in which five raters graded 30 photographs, inter-rater agreement was 67.7% and 72.3%. So we do not tell you “we will smooth out your nasolabial folds”; we first tell you what can actually be changed in this area.

The order we actually work through in consultation

1. We separate the fold from the wrinkle from the shadow

What is visible in the nasolabial area is usually the sum of three things — the groove made by the skin actually folding, the step made by the weight of the cheek tissue above it, and the shadow made by the light catching on that step. The third changes greatly with the lighting and the angle. So it is common for it to look different in the morning mirror and the evening mirror, and this is not an illusion but the consequence of the object of measurement itself being dependent on the light.

2. We put what the scale measures into a table

It matters to read the third row and the fourth row together. The three-dimensional measurement shows that the grade is correlated with depth as well, but the correlation with the grey value, at 0.985, is the stronger. That is, the grade does reflect depth, but the route it takes there passes largely through “light.” So the grade can come down even if the depth is left as it is and only the step is made gentler. This is not a trick of the eye; it means that this is how the human eye sees it in the first place, and it tells us what the real goal of the treatment design is.

3. We tell you as it stands the material in which the grade came down with filler

There is material in which hyaluronic acid was injected into moderate or more severe nasolabial folds — in 54 people the grade came down from 3.74 ± 0.45 to 1.63 ± 0.59 at one month (p < 0.05) and the grey value also fell significantly. In a separate set of material from 30 people, the grade and the length · width · depth had all fallen significantly at three months. Neither set of material had a control group. And in both the follow-up runs to one month and three months — the “lasts a year” type of figure that circulates widely cannot be spoken of from this material.

4. We say that the nasolabial fold may not be a problem of the nasolabial area alone

There is an anatomical view that as the retaining ligaments of the face loosen, laxity of the zygomatic ligament leads to deepening of the nasolabial fold. On this view, supporting the area above it is more in keeping with the direction of things than filling the groove directly. That said, the material reporting that technique is a case series of 45 people with no control group, judged only by global assessment at three months. We say alongside it that the grade of evidence is low. The situation on the cheek side we have written about in cheek sagging in Daegu — is there a treatment that deals with the cheek alone.

5. So this is the order we decide in

(1) We separate out whether it is the groove itself, the step above it, or something that deepens only with expression → (2) if it is the groove we put the filling classes on the candidate list, and if it is the step, the supporting or tightening classes → (3) we tell you the sample size · presence of a control group · length of follow-up for each candidate → (4) we settle the criterion for judging before the treatment (photographs under the same lighting · at the same angle · with the same expression) → (5) and on top of that we decide together. Price and discounts enter nowhere in this order; costs are explained separately at the consultation.

Five things worth asking at a consultation

These are questions you can ask at any clinic. If the answers are specific and the place says it does not know what it does not know, that helps a judgement.

1. “Is my nasolabial fold the groove, or the step above it?” — the classes for these two are different.
2. “What do you judge improvement by?” — whether by a grade or by measurement, and whether the lighting conditions are held fixed.
3. “How long is the follow-up of that evidence?” — a good deal of the material runs to one month or three months.
4. “Is that material with a control group?” — material without a control group is common in the nasolabial field.
5. “If there is a reason not to recommend it for me, what is it?” — an explanation that does not state the limits is not material for a judgement.

What is confirmed / what is inferred / what we could not confirm / material pointing the other way

Where this article was written

• Miso Clinic, Daegu · 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu, Republic of Korea (near Kyungpook National University Hospital station)
• Director Lee Chi-Hak · Tel. 053-428-2700
• This column was written by the director and reviewed in September 2026.

This article was written not to recommend a particular treatment but to set out the extent of the data needed for a decision. Judgement about an individual condition requires examination, and this article does not substitute for medical care. As companion pieces it helps to read cheek sagging in Daegu — is there a treatment that deals with the cheek alone and facial sagging in Daegu — starting with which layer the treatment works on.

Frequently asked questions

Who wrote this

References

1. Original validation of the wrinkle severity scale — Day DJ, Littler CM, Swift RW, Gottlieb S, American Journal of Clinical Dermatology 2004;5(1):49–52, PMID 14979743, DOI 10.2165/00128071-200405010-00007. 5 raters graded the left and right sides of 30 photographs of the lower face separately on five grades, with re-assessment at least two weeks later. Intra-rater agreement 68.7% · 72.7%, inter-rater 67.7% · 72.3% (weighted κ 0.75 · 0.78).
2. Nasolabial fold optical numerical scale — Lorenc ZP, Smith S, Bass LS, Bank D, Weiss R, Canfield D, D’Alessandro BM, Cramer LM, Journal of Drugs in Dermatology 2024;23(1):1319–1324, PMID 38206141, DOI 10.36849/JDD.7316. 73 subjects · three board-certified raters · two sessions two weeks apart. The paper states the object of the scale’s measurement as “the presence of depression and shadowing.”
3. Correlation of grade with grey value — Long X, Huang C, Zhao Q, Wang X, Ping W, Journal of Craniofacial Surgery 2025;36(3):966–969, PMID 39730116, DOI 10.1097/SCS.0000000000010778. 100 healthy people (86 women · 14 men, mean 41.85 ± 11.53 years). Correlation of grade with grey value r = 0.985 (p < 0.05). Hyaluronic acid was then injected in 54 people with moderate or more severe folds (mean 42.9 ± 8.9 years), and at one month the grade was 3.74 ± 0.45 → 1.63 ± 0.59 (p < 0.05). There was no control group.
4. Three-dimensional morphometry — Wang D, Zeng N, Zhang Q, Wu Y, Aesthetic Plastic Surgery 2022;46(5):2189–2193, PMID 35034152, DOI 10.1007/s00266-021-02682-w. 75 Asian women volunteers. The grade was significantly positively correlated with the length · width · depth of the nasolabial fold respectively. After injection of hyaluronic acid in 30 people with moderate or more severe folds, all four values had fallen significantly at three months. There was no control group.
5. Deep learning automatic grading — Cui H, Zhang Z, Zhang W, Zhang J, Cui H, Aesthetic Surgery Journal 2026;46(2):130–136, PMID 40798848, DOI 10.1093/asj/sjaf161. 6,718 facial images (1,718 from the clinic outpatient setting plus 5,000 from a public celebrity dataset), graded independently half-face by three plastic surgeons. Ensemble model validation accuracy · F1 0.917. The authors wrote that existing grading is “inherently subjective and vulnerable to inter-rater variation.” The majority of the training data differs from the distribution of the people seen in the clinic.
6. An injection technique from the standpoint of the retaining ligaments — Cohen S, Artzi O, Mehrabi JN, Heller L, Journal of Cosmetic Dermatology 2020;19(8):1948–1954, PMID 32543088, DOI 10.1111/jocd.13546. A case series of 45 people · no control group · global assessment at three months. It is a report of a technique of injecting beneath the fascia along a chosen vector on the premise that laxity of the zygomatic ligament contributes to deepening of the nasolabial fold. The design is of a low grade of evidence.
7. Legislation on medical advertising — Article 56(2) of the Korean Medical Service Act. It prohibits advertising by means of accounts of treatment experience, comparison with other medical institutions, superlative expressions and the like. This is why this column carries no expressions such as “good at” or “the best,” no comparison with other medical institutions, and no prices or discounts.