Wrinkles Nasolabial Folds
- Best ResultsImmediate to days
- Treatment Recovery0 days
- Procedure Time1-10 minutes
- Skin SpecialistNurse
- Duration of ResultsMonths
- AnaestheticNA
- Back to WorkImmediately
- Cost$-$$
Wrinkles - Nasolabial Folds
Probably still the number one requested area to correct. This laugh line has been the topic of debate amongst dermatologists & plastic surgeons for nearly two decades. Treatments are easy; however correction of laugh lines may not give the most pleasing aesthetic results, read more to understand why.
FactsFacts on Nasolabial Fold Wrinkles
- Dermal fillers can lessen nasolabial fold lines
- Other options include skin tightening devices
- HIFU or high intensity focused ultrasound can provide lifting
- Radiofrequency is another option to lift laugh lines
- PDO threads can give good results in some cases
What are Nasolabial Folds?
The nasolabial folds are referred to as smile lines or laugh lines. This fold separates the cheeks from the mouth. They run from the nose to the corners of the lips.
As we age, our face changes in many ways which eventually leads to these folds descending, becoming more prominent & deeper. The most important thing to grasp is that these folds are normal. The aim of treatment is to lessen the look of the NL fold.
What is the best treatment for nasolabial folds?
It really depends on the depth of your folds as well as your facial shape, skin quality, laxity, & ethnicity. In most cases, dermal fillers in, or near the fold can help reduce the depth of NL folds. Other treatments include-
- Skin tightening with HIFU, RF, Tempsure, Pelleve, Thermage
- RF microneedling with Infini, Genius, Morpheus 8, Intensif, Secret
- Fat transfer including nano-fat & ASC
- Laser resurfacing with CO2; if skin quality is an issue
- Surgical face lifting if associated with mid face laxity
I tend not to treat the fold itself (as in this pic.), I prefer to support & blunt the folds medially.
Which filler is best?
For nasolabial folds I usually employ a thicker filler at the base. It gives support & lifts the medial cheek without adding volume. I also use a thinner filler in the NL fold itself, delivered via a cannula.
I work with brands across 5 ranges, & I select the best product from each company portfolio.
Which filler lasts the longest?
Non- HA fillers, in theory, last longer than HA fillers. The former includes PLLA (Poly L lactic acid or Sculptra). Calcium hydroxyapatite fillers can also last longer than HA. Collagen stimulating fillers–
Pros: Last longer, stimulate collagen, in the long run cheaper than HA fillers
Cons: Not reversible, if you get this in an artery you are in big trouble.
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How to reduce the chances of intra-arterial injections when treating nasolabial lines?
Any experienced injector will know how to reduce side effects. I use a big diameter cannula when injecting this fold. I also move my cannula in different depths & inject accordingly. The level of injection in the piriform fossa is on bone. In this area I use a needle.
Why look beyond the nasolabial folds?
Four words- facial harmony & balance. It is super easy to stick some filler to lessen the fold. Will this equate to balance & better aesthetics? In most cases, no. All I have done is to fill in a line.
The outcome of aesthetics should be an objective improvement in measurable aspects of beautification. The argument is that if the consumer or patient feels or perceives that a nasolabial fold is their main irk, then certainly by filling it in, their objective is met. If this is your main objective, knock yourself out.
What can threads achieve?
Threads can give a good correction in the depth & prominence of NL folds. The best results are with suspension threads. These include Mint, Silhouette & Aptos threads. The duration of results ranges from 4 to 12 months.
Mono PDO threads can also give good results in patients with mild to moderate laxity & medium depth nasolabial folds. These have much fewer side effects compared to suspension threads & are best combined with energy devices that heat your skin.
Book an appointment with my nursing team to see if threads suit your NL depth.
How can HIFU or Ulthreapy help?
Skin tightening devices can help reduce nasolabial lines IF –
- There is mild to moderate laxity
- Your dermal layer is medium to thick
- If your collagen is not broken or fragmented
The most important aspect about non-surgical skin tightening devices is patient selection. My clinical staff are extensively trained to provide the best advice. This ensures the highest chance of success.
Note: HIFU / microfocused ultrasound & RF devices such as Pelleve, Tempsure, Thermage are more successful in Ethnic patients with little or no sun damage.
Can fat transfer treat nasolabials?
Yes. I occasionally perform fat transfer, especially in large volume deficits. The problem of fat is that this procedure is not as predictable as dermal fillers. Fat also does not have the finesse of fillers; however, the advantage is that it is natural, & with large volume corrections can be more economical.
I inject fat with an 18 G cannula, hence the risk of intra-arterial occlusion is infinitely small.
Can surgery remove nasolabial folds?
A face lift can reduce nasolabial folds as this surgical procedure lifts the deeper structures including the SMAS. There are some reports of surgical subcision for the NL folds, this is totally bullsh*t. In most cases it is combined with dermal filler. It is the filler, delivered via a cannula that gives the results & not subcision.
Can microneedling treat nasolabial folds?
If you have a microneedling machine, you can treat virtually anything with needling. The question should be, is microneedling an effective treatment for nasolabials? The answer is no. Less than 5% will have a ‘good’ result. RF microneedling is better, however downtime is longer (and costs).
What treatments do not work?
The two BS treatments that come to mind are-
- LED or low laser LED phototherapy using blue, red or orange light sources. These are marketed as miracle skin rejuvenation treatments that can increase collagen (in a petri dish). Absolute waste of money.
- PRP or platelet rich plasma is another BS treatment in the context of skin rejuvenation. It does not provide volume, and it does not lift. It can be useful for hair loss, but it cannot correct nasolabial folds.
Can NS folds be addressed naturally?
Yes & no. Dermal fillers are a product of streptococcus. Natural enough? Fat transfer is natural, as it uses your own adipose tissue. In most cases I re-inject fat without processing it, just washing it with saline.
If you are after a non-procedural method, you can try collagen supplements. At the very least, your joints will thank you.
Can anti-wrinkle injections reduce nasolabial folds?
I think you are referring to Botox, correct? No, anti-wrinkle injections are not used to treat the NL folds. Tox can reduce other facial depressors such as the depressor angularis oris or DAOs that pull down the corners of the mouth.
This groove is different from the NL folds that go from the nose to the angle of the mouth.
Can skin care reduce skin folds?
Not a chance. Skin care can improve skin quality, reduce fine lines & wrinkles, but it can not lift or make NL folds more shallow.
In fact using strong ingredients such as retinoids will irritate the skin of the folds, making everything look & feel worse.
Skincare is not the answer to everything.
Davin’s Viewpoint on Nasolabial Folds
Nasolabial folds are not necessarily unattractive. They are natural however deep grooves can pull at the corners of the mouth and give a person an unattractive scowl (more DAOs in this context). Deep furrows can make a person look many years older than they are.
I have a hard time convincing patients NOT to get specific lines ‘filled in’ as this will give an unnatural look. Yes, I was guilty of filling in the NL folds in the early 2000s when we did not know any better. Fast forward to 2022 & beyond, & we all know the importance of facial harmony & balance. In many cases my NL fold treatment is to blunt the angle & lessen the piriform shadow. This indirectly reduces NLF depth & importantly supports the medial cheek. I believe this injection point will suit most people, especially if there is associated lower face laxity. My viewpoint is that adding too much filler ‘drags’ the lower face inferiorly, especially if fillers take in water (or accumulate with time). Compound with the fact that most patients also have associated areas such as the marionettes & pre-jowl sulcus treated at the same time. This further adds to the volume of the lower face.
Fat transfer is an interesting proposition. In the context of safety, my practice is to inject with a huge 18 G cannula. The limiting aspect of fat is the unpredictability with absorption.
For those who are against injectables (then you’re reading the wrong website), there are always PDO threads. Results are much less predictable than fillers. Ideally PDOs are combined with energy devices. I do not like using suspension threads just to lift the NL folds as results are relatively short lived (average 6 months). This group of threads just don’t do it for me, especially when you look at the risk benefit ratio & duration of action.
