Should Nasolabial Folds Be Filled With Filler or Lifted?

Why do nasolabial folds get deeper?

The nasolabial fold is the line running from beside the nostril to just outside the corner of the mouth. Everyone has it. It is the border where the cheek meets the upper lip area, so it is normal for it to crease when you smile.

With age, this border gets deeper. Midface cheek tissue moves downward with gravity and lost elasticity, while fat and volume around the bone deep beside the nose decrease. Tissue piles up above and support is lost below, so the height difference across the border grows.

That is why the same-looking fold can have different causes. A person whose cheek has descended and a person whose nose-side area has hollowed need nearly opposite treatment.

Is my fold the sagging type or the hollow type?

You can roughly tell by looking in a mirror with a relaxed face, from the front and the side. If the cheek outside the fold bulges and hangs over the line, it is the sagging type. If the area inside the fold, beside the nose and mouth, has sunken in, it is the hollow type.

If the fold becomes clearly fainter when you lie down, sagging plays a larger role. If the groove beside the nose stays even when lying down, volume loss plays a larger role.

In reality, most faces have a mix of both. At the visit we look at skin thickness and elasticity, the amount of cheek fat, and differences between the left and right sides, and decide the order based on which cause dominates.

How is a hollow fold filled?

A hollow fold is treated mainly by restoring the lost support. The fold receives force every time you smile, talk or chew, so what we inject needs to stay in place without spreading or shifting. At Serene Clinic we choose among Neuvia filler, Radiesse and the Gouri Wrinkle Eraser Injection depending on the shape and depth of the hollow.

For a clearly grooved fold, we mainly use Neuvia, a highly cohesive PEG-crosslinked hyaluronic acid filler. It isn't just firm; the gel holds together, which we find helps keep the designed line stable even in areas with a lot of facial movement.

If the deep support beside the nose has been lost substantially, we consider Radiesse. Radiesse is made of calcium hydroxylapatite (CaHA): right after injection the gel fills volume, and afterward collagen forms around the particles to maintain support. A multicenter randomized study in nasolabial folds reported sustained improvement and patient satisfaction over 12 months of follow-up [1]. For people who find filler a burden and also worry about nodules from collagen stimulators, we recommend the Gouri Wrinkle Eraser Injection.

The Gouri Wrinkle Eraser Injection is a method devised by Serene Clinic's director: Gouri, a liquid PCL, is mixed with a long-lasting hyaluronic acid product and injected in small amounts along the line. When mixed with hyaluronic acid, Gouri spreads less and tends to stay in place. The change is gradual: while the hyaluronic acid remains, collagen forms and the skin slowly thickens. We describe the duration as about 5–6 months after one session and over a year after 2–3 sessions, with individual variation. Because it is a liquid rather than a particle-based collagen injection, there is less concern about palpable nodules.

How is a sagging fold lifted?

For a sagging fold, the first step is to move the descended cheek tissue back into place. Adding filler to a sagging fold first adds weight and can make the cheek look heavier. There are two ways to reposition: device lifting and thread lifting.

Device lifting uses heat energy to tighten tissue and stimulate collagen. When sagging has reached the SMAS layer, we plan around ultrasound lifting with Ulthera or Coolsonic; when skin elasticity and fine lines are also a concern, around radiofrequency lifting with Xerf. Before treatment we check fat thickness above the fold and in the deep cheek, and the depth of the SMAS, with ultrasound, and divide energy by zone. Some change is visible right away, and firmness builds over the following months.

A thread lift places absorbable threads under the skin to physically suspend sagging midface tissue. At Serene Clinic we use barbed (cog) threads. It suits cases where device lifting alone doesn't reposition enough or where you want the sagging cheek lifted right away, and it is sometimes planned together with device lifting. For 1–2 weeks afterward there may be tightness, swelling, or slight dimpling of the skin. The effect fades as the threads dissolve, and a systematic review found that evidence on how long the lift lasts is still limited [2], so we explain what duration to expect in advance.

If I have both sagging and hollowing, which comes first?

If both forms are present, we usually reposition first with device lifting or a thread lift, then fill the remaining hollow. Once the sagging tissue is lifted, the groove often turns out shallower than expected, so less filling is needed.

Both can be done on the same day. But if a lot of filler is likely needed, it is more accurate to reassess after the swelling from lifting has gone down and then decide the amount.

Why does too much nasolabial filler look unnatural?

If you keep adding filler to erase the groove completely, the area beside the nose can bulge, the midface can look wider, and the cheeks can look bunched when you smile. The nasolabial fold is a natural border, so the goal is not to erase the line but to reduce its depth to suit your age.

Serene Clinic matches nasolabial filler to the relaxed face. We do not ask you to make expressions during the procedure to decide the amount. Trying to fill even the line that appears when smiling easily leads to overcorrection.

If you are very worried that the filler will move every time you smile, it may be right not to have filler at all. If you choose filler, we use a product that holds its place well and inject small amounts only where needed.

What precautions and side effects should I know about?

For filler, we use numbing cream together with local anesthetic injection to minimize pain, and you can return to daily activities right away. Swelling and bruising at the injection sites can last from a few days to 2 weeks. On the day of treatment, it is best to avoid spicy and hot food, alcohol, and saunas.

If the fold looks even deeper around one week after filler, it may be temporary swelling. If a bulge toward the cheek remains after 2 to 3 weeks or more, the filler may have moved, so we check its position by touch and ultrasound.

The fold area has blood vessels running through it, so vascular complications can rarely occur. If the skin turns white or dark red-purple after treatment and pain gets worse, contact the clinic right away. After energy lifting there may be temporary redness, swelling or stiffness, which usually settles within a few days. After a thread lift, it's best to avoid opening your mouth wide or rubbing your face hard for about 1–2 weeks.

Prices (as of the October 2026 menu)

The treatment and amount needed depend on the type and extent of your nasolabial folds, so we explain them after an exam.

Frequently asked questions

References

1. Moers-Carpi M, Vogt S, Santos BM, et al. A multicenter, randomized trial comparing calcium hydroxylapatite to two hyaluronic acids for treatment of nasolabial folds. Dermatol Surg. 2007;33(Suppl 2):S144-S151.
2. Gülbitti HA, Colebunders B, Pirayesh A, et al. Thread-lift sutures: still in the lift? A systematic review of the literature. Plast Reconstr Surg. 2018;141(3):341e-347e.