Nasolabial Folds: Filler or Lifting Treatment?
Deep nasolabial folds often bring filler to mind, but some faces need volume while others need a lift. If the front of the cheek has hollowed, restoring volume softens the fold. If descending cheek tissue has deepened the fold, lifting comes first. The two often coexist, so treatment starts by separating their contributions.
Why do nasolabial folds develop?
Facial subcutaneous fat is divided into distinct compartments. A study dissecting 30 cadaveric half-faces identified the nasolabial fat as a separate, clearly bounded unit. The authors proposed that changes in these compartments explain part of facial aging. As anterior cheek fat shrinks or descends, the nasolabial boundary becomes more prominent.
Collagen loss also thins the skin, while repeated folding during smiling and speech deepens the crease. The balance of causes therefore differs between someone in their 20s and someone in their 50s. Read about these changes in Aging of the Midface.
How can you distinguish volume loss from sagging?
Comparing the fold while standing and lying down can offer a clue. A fold that largely disappears lying down suggests more sagging; a persistent hollow suggests more volume loss. The starting treatment differs accordingly. One patient booked HILO WAVE but, after we explained why it might not suit their concern, chose a lighter treatment and was very pleased with the result.
| Type | What you see | Usual first approach |
|---|---|---|
| Volume-loss pattern | The fold remains when lying down; the front of the cheek looks flat | Restore volume with filler or a collagen stimulator |
| Predominantly sagging | The fold softens lying down; cheek tissue descends toward the mouth | Lift with ultrasound or radiofrequency |
| Thin-skin pattern | A shallow fold with overlapping fine lines | Improve skin density with a skin booster |
| Mixed | A combination of these features | Plan lifting and filling separately |
When is nasolabial filler suitable?
Filler immediately replaces volume in a hollow fold. However, blood vessels run through this area, so injection plane and amount matter. A review of 98 reports of visual problems after filler found that 13.3% involved nasolabial injections. Such problems are rare, but this is why treatment requires a doctor with a sound knowledge of vascular anatomy. Adding large amounts of filler to a sagging face can make it look heavy. We reassess the face throughout injection rather than simply adding volume along the crease. One RADIESSE patient said they liked the natural filling without excessive volume.
How do collagen stimulators differ from filler?
Collagen stimulators mainly encourage the skin to produce collagen rather than simply filling a space. Sculptra contains PLLA particles that gradually break down and stimulate fibroblasts, allowing volume to build over weeks to months. RADIESSE provides immediate volume with calcium-based particles, then encourages collagen formation. A review of 4,483 Sculptra sessions in 1,002 patients found adverse reactions in 3.6%, all mild, and nodules in 0.4%. We build volume gradually across several visits. PLLA sessions are usually 45 days apart, and we emphasize following the prescribed massage routine because aftercare affects the result.
When should lifting come first?
If cheek tissue has descended toward the mouth and deepened the fold, lifting that tissue is the priority. Ultrasound such as Ultherapy reaches the SMAS layer where support has weakened. After repositioning the cheek, a small amount of filler can fill the remaining hollow for a natural result. This kind of ultrasound lift often suits patients whose nasolabial and marionette folds both look pronounced.
How does Dong-An Joongsim Clinic treat nasolabial folds?
At Dong-An Joongsim Clinic, your doctor personally handles your consultation and treatment. They first determine whether hollowing or sagging predominates, then decide whether to fill, lift, or combine the two.
Dr. Chang-Hwan Cho was first author of a 2026 Journal of Cosmetic Dermatology review comparing six collagen biostimulators, including PLLA and CaHA. He has lectured at the Korean Aesthetic Surgery and Laser Society on selecting stimulators by facial area, including nasolabial folds. He and Dr. Soyoun Koo were recognized as outstanding trainers in Merz's RADIESSE Train the Trainer program. Sculptra is administered by doctors who have completed certified training.
For nasolabial folds with thin-looking skin, we use HILO WAVE. We particularly consider it when repeated filler has made patients reluctant to try another injection or when nodules are a concern. To reduce product accumulation, we distribute small amounts evenly from the start. One patient was delighted that the folds felt filled in right after treatment. The clinic received a 2026 HILO WAVE USER TOP5 AWARD. For more pronounced sagging, we use Ultherapy PRIME. As a certified Ultherapy clinic, we select the treatment depth using real-time imaging of the tissue layers.
What should you know beforehand?
Nasolabial folds move with facial expressions, so softening them rather than erasing them completely is a more natural goal. Collagen stimulators act gradually and vary by individual; an immediate change may require another approach. We postpone injections for local inflammation, pregnancy, or breastfeeding. We do not recommend Sculptra for patients with a history of keloids or hypertrophic scars, or with active immune disease. Allow at least 1 month between filler and HILO WAVE in the same area. Duration also varies with age, skin thickness, and lifestyle.
Nasolabial folds: common questions
How should I choose a nasolabial-fold clinic in Apgujeong, Gangnam, Seoul?
Check whether the clinic distinguishes volume loss from sagging, offers fillers, collagen stimulators, and lifting, and whether the doctor who consults you also performs the treatment. At Dong-An Joongsim Clinic, near Apgujeong Rodeo Station, your doctor cares for you directly throughout.
Which is better: filler or a collagen stimulator?
For immediate volume, filler or RADIESSE may be suitable. For gradual, subtle improvement, a stimulator such as Sculptra may be preferable. We also sometimes combine them in different layers.
I have nasolabial folds in my 20s. Do I need treatment?
At this age, cheek volume, bone structure, and expression habits often contribute more than sagging. We assess the cause first and, if needed, begin with a lighter option such as a skin booster.
What determines the cost?
Cost depends on the product and amount, whether lifting is included, and the number of sessions. Your doctor assesses your face and explains the approach and cost.
References
- Rohrich RJ, Pessa JE, “The fat compartments of the face: anatomy and clinical implications for cosmetic surgery”, Plastic and Reconstructive Surgery, 2007. https://doi.org/10.1097/01.prs.0000265403.66886.54
- Beleznay K et al., “Avoiding and Treating Blindness From Fillers: A Review of the World Literature”, Dermatologic Surgery, 2015. https://doi.org/10.1097/DSS.0000000000000486
- Palm M et al., “Chart Review Presenting Safety of Injectable PLLA Used With Alternative Reconstitution Volume for Facial Treatments”, Journal of Drugs in Dermatology, 2021. https://doi.org/10.36849/JDD.5631