Treating Nasolabial Folds with Fillers: My Approach to Restoring Midface Architecture

It’s often said that nasolabial folds are the first real sign of facial ageing that people notice - and for many, they’re the one that’s hardest to ignore. These lines, running from the corner of the nose to the edge of the mouth, can make the face appear tired, heavy or simply less youthful. Treating these lines effectively relies on understanding why that crease exists in the first place, and how we can restore the natural contours that time has quietly diminished.

What Causes Nasolabial Folds?

The nasolabial fold isn’t technically a wrinkle at all. Instead it’s a structural feature of the face that deepens as the underlying scaffolding shifts. With age, we lose both bone and deep fat in the midface, particularly in the malar and sub-malar regions. The fat pads that once sat higher up begin to descend towards the centre of the face and deflate, while ligaments tethering the skin around the mouth remain firmly in place. This creates a visible transition between the fuller midface above and the relative hollowness below.

Compounding this, collagen and elastin decline in the dermis and deeper layers reduces skin elasticity, while repetitive facial expressions (smiling, laughing, talking) reinforce the fold. Extrinsic factors including gravity, sun exposure and genetics all contribute, but volume loss is almost always the leading culprit. This is why, when someone comes to me asking to fill the line, my response is usually: Let’s do some revolumising first.  

When Should You Consider Nasolabial Fold Filler Treatment?

If you notice that your smile lines remain even when your face is at rest, or you find that makeup tends to settle in the folds, it may be time to consider professional treatment if the lines are bothering you. However, the ideal moment is before the fold becomes deeply etched. Preventive volume restoration with dermal fillers can help to maintain youthful facial architecture for longer and may avoid the need for more aggressive correction later on.

How Dermal Fillers Work to Treat Nasolabial Folds

Dermal fillers used for nasolabial folds are almost always hyaluronic acid (HA) based.  Hyaluronic acid is a molecule naturally present in skin and connective tissue and forms an important component of the structural matrix of the skin and other tissues. HA is known as a ‘humectant’, meaning it can bind water molecules to itself.  Indeed, HA binds water up to 1,000 times its molecular weight.   In filler form, HA is cross-linked, meaning that the long chains of hyaluronic acid molecules are stuck together with another chemical (common ‘cross-linking agents’ are molecules like BDDE). This helps the filler gel resist degradation and remain in the tissue for 6–18 months.

The science of filler behaviour revolves around ‘rheology’ its flow and deformation characteristics:

• Elastic modulus or G-prime (G’) measures firmness or lifting capacity.  High G’ fillers like Juvederm Voluma are ideal for restoring structural support deep on bone, whereas lower G’ fillers (for example Teosyal Redensity 2) are better for more delicate areas such as the tear trough.
• Viscosity (η*) describes how resistant the gel is to spreading; thicker fillers maintain shape under facial movement.
• Cohesivity ensures the filler integrates smoothly with tissue rather than lumping or migrating.

When HA filler is injected it immediately restores volume but over time it also stimulates fibroblast activity.  This improves dermal matrix quality  and may be a reason why fillers (or at least the effect of fillers) can last longer than expected (Kablik et al., 2009).  This dual effect - shorter term mechanical lift and longer term biological support makes fillers both corrective and potentially regenerative.

When injected strategically, HA filler can restoring structural support to key areas of the face, often higher up than the fold itself. The idea is that with gentle revolumisation: We can lift, reposition and smooth the overlying tissue and this in turn reduces the shadowing that makes the fold appear deep.

Treating Nasolabial folds with fillers: Lift Before You Fill

Overfilling the nasolabial fold directly can make the midface look puffy - a common aesthetic misstep. My approach is to restore volume where it has been lost (I.e. deep on the bone of the midface), not where it has collected.

In most cases, the midface is treated first. By lifting the cheek and restoring malar support, the fold naturally softens as the tissue above is gently elevated back to where it used to be. Once that foundational support is in place, I’ll reassess whether any subtle filler is needed directly within the fold. Usually a very small amount of low G’ filler in the fold is all that is needed to soften it significantly.

This ‘less is more’ approach maintains a crisp nasolabial contour (we all have these folds!) while removing the fatigue and heaviness that often prompt patients to seek treatment. As always, the patient’s individual characteristics should be maintained - we are not trying to create whole new faces (this never works well!).

Technique and Safety Considerations for Nasolabial Fold Fillers

The nasolabial region is rich in blood vessels, including branches of the facial artery so technique and anatomical knowledge are critical. I typically use a combination of deep injections on the surface of the bone along the midface to create lift and then a microdroplet technique for any refining work around the fold itself. This minimises bruising and allows smooth, even product placement.

For younger patients or those with early signs of volume change, I often combine filler treatment with skin-quality boosters such as Profhilo or polynucleotides (such as Newest by Plinest) to improve hydration and elasticity, preventing the need for more volume later on. For more advanced ageing, adjunctive treatments such as Morpheus8, UltraClear laser resurfacing can complement fillers by improving skin tone and tightness by increasing collagen density around the lower face.

Results: What to Expect from Nasolabial Fold Fillers

Immediately after treatment, you’ll see a visible softening of the folds, though the final result continues to refine over the following days as the filler integrates with the tissue and any minor swelling subsides. When done correctly, the change is subtle yet transformative (the ideal is that your friends may say you look fresh but won’t be able to pinpoint why!).

Results typically last 12 to 18 months depending on the product used and individual metabolism and injection depth. Periodic maintenance can prevent regression and maintain facial architecture over time.

Bruising or mild swelling may last 24–48 hours.

Combining Treatments for Holistic Rejuvenation

Treating the nasolabial folds in isolation rarely achieves the best results.  A truly rejuvenated face requires harmony between multiple features eyes, cheeks, chin and jawline all working together. Treating elements of the face in isolation can be an aesthetic disaster. Sometimes, I’ll integrate a small amount of filler along the corners of the mouth or chin to balance expression lines, or use toxins to subtly relax the depressor muscles that pull the midface downwards.

Equally, skin health remains fundamental. Using medical-grade skincare rich in retinoids, vitamin C and daily high-factor, broad spectrum sunscreen will prolong the longevity of filler results and support ongoing collagen synthesis. My own skincare range is built around this principle of skin optimisation both pre- and post-procedure.

The Takeaway

Treating nasolabial folds is as much art as it is science. The key to achieving a good result is restoration of your individual facial proportions (and not striving towards an imagined ‘ideal’ ratio), ageing patterns and the subtle interplay between support and expression. My goal is always to enhance, not alter, and to restore the light and lift that define a balanced face. In skilled hands, filler for nasolabial folds should never look overdone.

If you feel you would benefit from a treatment for your nasolabial folds, why not book in with one of our practitioners in clinic for a consultation.

References

Kablik, J., Monheit, G.D., Yu, L., Chang, G. and Gershkovich, J. (2009). Comparative physical properties of hyaluronic acid dermal fillers [Journal article] in Dermatologic Surgery, 35 (Suppl 1), pp. 302–312. Available at: https://pubmed.ncbi.nlm.nih.gov/19207319/ [Accessed 2 November 2025].

Funt, D. and Pavicic, T. (2013). Dermal fillers in aesthetics: an overview of adverse events and treatment approaches [Journal article] in Clinical, Cosmetic and Investigational Dermatology, 8, pp. 295–316. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC3865975/ [Accessed 2 November 2025].

Stocks, D., Sundaram, H., Michaels, J., Durrani, M.J., Wortzman, M.S. and Nelson, D.B. (2011). Rheological evaluation of the physical properties of hyaluronic acid dermal fillers [Journal article] in Journal of Drugs in Dermatology, 10 (9), pp. 974–980. Available at: https://cannz.co.nz/wp-content/uploads/2020/05/Ref-1_Stocks-et-al_JDrugsDermatol_2011.pdf [Accessed 2 November 2025].

Soares, D.J. (2022). Bridging a century-old problem: The pathophysiology and molecular mechanisms of HA filler-induced vascular occlusion (FIVO) – Implications for therapeutic interventions [Journal article] in Molecules, 27 (17), p. 5398. Available at: https://doi.org/10.3390/molecules27175398 [Accessed 2 November 2025].