Nasolabial folds — the answer starts by separating the cause
“What treatment works for nasolabial folds?” has no single answer. A nasolabial fold is not a crease in folded skin. It is a structural boundary created where facial muscle attaches directly to the dermis, and three causes overlap along it. Which of the three dominates decides the direction. And this region is where the facial artery runs.
The short answer
A nasolabial fold is not a wrinkle made by skin folding. It is a structural boundary created where facial muscles attach directly to the dermis, and three things overlap along it — dermal attachment of the levator labii superioris group, descent of the cheek fat compartments, and bone resorption of the maxilla. So “what treatment for nasolabial folds” has no single answer. If the main problem is lost volume, the direction is filling; if it is descended cheek fat, the direction is lifting or tightening; if it is a line drawn by muscle attachment, the line remains even after filling. And the first thing to state is risk — the facial artery runs through this region. Among 365 newly reported cases of visual loss after filler injection overall, 6.0% recovered completely and 68.2% did not recover at all (Doyon VC et al., PMID 38630871). Those figures are for filler injection as a whole, not for nasolabial folds specifically, but they belong beside any judgment about the risk of this region.
What a nasolabial fold actually is
What you see in the mirror is one line, but three things make it. Treating the nasolabial fold as a single phenomenon blurs three different answers into one.
| Cause | What happens | Does filling solve it? |
|---|---|---|
| Dermal attachment of facial muscle | The levator labii superioris group attaches directly to the dermis, so skin is pulled along that line with every smile | No — the attachment itself does not disappear when you fill |
| Descent of cheek fat compartments | Fat above descends, so the area above the boundary thickens while the area below looks relatively hollow | Partly — but filling is not the same as raising what descended |
| Bone resorption of the maxilla | The bone recedes, so the entire soft tissue above it loses its support | It can be reinforced by filling, but the volume required grows |
The weight of these three differs from person to person. Two people who arrive using the same words, “nasolabial folds”, often need different treatments. The anatomy itself is set out in more detail in why nasolabial folds deepen.
What is not the answer
Three expectations come up often enough in consultations that we address them first. Stating these before the options usually helps the decision more than the options do.
“Filling makes it disappear.” When muscle attachment is the main cause, the line remains after filling. Adding more volume tends to make smiling look unnatural instead. Where natural and artificial diverge is set out in what separates a natural result from an artificial one.
“A collagen booster removes nasolabial folds.” Booster products target dermal density and texture. A nasolabial fold is a problem of structure, not of dermal density, so the direction differs. That does not mean boosters are pointless — it means aiming them primarily at the nasolabial fold is a mismatch.
“Lifting flattens nasolabial folds.” Radiofrequency and focused ultrasound target sagging. If descended cheek fat is the main cause, the direction is right; if bone resorption or muscle attachment dominates, the result falls short of the expectation. On sequencing, see booster first, or lifting first.
How thick the evidence is, by class
| Class | What has been shown for nasolabial folds | Caution in this region |
|---|---|---|
| Dermal filler | The thickest body of data, for the purpose of volume reinforcement | The facial artery runs here. Among 365 cases of visual loss after filler overall: complete recovery 6.0%, no recovery 68.2% (Doyon VC et al., PMID 38630871) |
| Threads | Evidence is thinner than for filler | Hard to reverse, and it changes how repeat treatment must be designed |
| Focused ultrasound (HIFU) | Creates point coagulation zones at set depths | Targets the sagging above the fold rather than the fold itself |
| Radiofrequency (RF) | A 2026 systematic review covering 15 studies and 1,230 patients, of which one was a randomised controlled trial | No head-to-head study between devices was identified |
We write the thickness of the evidence as it stands, class by class. The sentence “this treatment is effective for nasolabial folds” carries a different weight for each class. In Korea the approved indication wording is generally “temporary improvement of facial wrinkles in adults through physical restoration”, which is separate from what the US FDA has cleared.
On combining treatments
Because a nasolabial fold has three causes, more than one approach is sometimes involved. We will state the limit precisely — “combining them works better” was not confirmed in the two randomised trials. When we do plan treatments together, the reason is not that it is better but that the layers being addressed are different. When bone resorption and fat descent are both present, each layer is addressed separately. When the cause narrows to one, we do one. We also say plainly that when several things are done together, it cannot be worked out afterwards which one acted.
The order we look in consultation
- We separate the smiling face from the resting face. A hollow that persists at rest points to structural loss; a line that deepens only on smiling points to muscle attachment.
- We look at the upper cheek too. Looking only at the fold misses the cause — we check whether something has descended.
- We check what has already been injected. Irreversible materials (PCL, PLLA, CaHA) already in this region change the plan.
- We raise vascular risk first. The facial artery runs through this region, so we say so before any decision to treat.
- We do not do everything at once. When there are three causes, we separate them in sequence.
Frequently asked questions
Is filler the best option for nasolabial folds?
It depends on the cause. If bone resorption or volume loss dominates, the direction is right. If the main cause is a line drawn by muscle attaching to the dermis, the line remains after filling. And because the facial artery runs through this region, the risk must be weighed alongside — among 365 newly reported cases of visual loss after filler overall, complete recovery was 6.0%.
How much of it goes away in one session?
The word “away” fits this fold poorly, because a boundary created by muscle attaching to the dermis is structure. How much it softens depends heavily on which of the three dominates — levator attachment, cheek fat descent, or maxillary bone resorption.
Do thread lifts raise nasolabial folds?
If descent of the cheek fat compartments is the main cause, the direction is right. But the evidence for threads is thinner than for filler, and they are difficult to reverse — both belong in the decision.
Does botulinum toxin work here?
Reducing the action of facial muscles is used in some regions, but at the nasolabial fold the muscles involved raise the upper lip, so too much makes smiling look unnatural. We are particularly conservative about treating muscle in this region.
Which clinic in Daegu is best for nasolabial folds?
There is no public metric comparing operator skill, so this cannot be answered from data. It is more useful to ask “in my case, which of the three is the main cause?” and choose the clinic whose answer is specific.
When should the result be judged?
Filler is at its maximum immediately and settles afterwards. For radiofrequency, clinician assessment was not significant at 4 weeks and was significant at 12 weeks, with the peak at 4 to 6 months (blinded-evaluator study in 20 Korean women). The point of judgment differs by class.
Who wrote this
Written and reviewed by Lee Chi-Hak, MD, medical director of Miso Clinic in Daegu, South Korea. Every study cited above is given together with its design, its size and the limitations the authors themselves recorded, and where we could not find data, we have said that we could not find any.
| Medical director | Lee Chi-Hak, MD |
|---|---|
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References
- Doyon VC et al., PMID 38630871 — 365 newly reported cases of visual loss after filler injection: complete recovery 6.0%, no recovery 68.2%
- 2026 systematic review — radiofrequency lifting, 15 studies and 1,230 patients, one randomised controlled trial; no head-to-head study between devices was identified
- Blinded-evaluator study in 20 Korean women — radiofrequency: clinician assessment not significant at 4 weeks, significant at 12 weeks, peak at 4 to 6 months
- Anatomy of the nasolabial fold — dermal attachment of the levator labii superioris group, descent of the cheek fat compartments, resorption of the maxilla
Everything in this column is general information and does not replace medical diagnosis or treatment. Effects and side effects vary with individual skin condition, age and underlying illness, and the same result is not guaranteed for everyone. Any decision to proceed should be made in an in-person consultation with a physician.
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