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    How is the nasolabial fold formed?

    The wrinkle between the nose and mouth fold divides anatomical regions of the face. To the side of the nasolabial fold are the cheeks, which contains various fatty tissue pads and a layer of connective tissue (SMAS). The upper lip on the other side of the nasolabial fold contains little subcutaneous fat and no separating connective tissue layer. Four facial muscles are connected to the skin at the sides of the nasolabial fold (levator labii superioris muscle, levator labii superioris alaeque nasi muscle, levator anguli oris muscle, and zygomaticus major and minor muscles). Several factors influence the shape and depth of the nasolabial fold. Muscle tone, the amount and position of subcutaneous adipose tissue, and skin elasticity all participate in the formation of the nasolabial fold. These characteristics are in turn influenced by inborn genetic predisposition, lifestyle habits, cigarette smoking and increased sun exposure. Therefore, a certain asymmetry is natural in nasolabial folds. The appearance of nasolabial folds has less to do with weight loss. Rather, the natural loss of collagen with advancing age is one of the main causes. Collagen is responsible for skin elasticity. Due to the lower concentration, the wrinkles between the nose and mouth decrease.

    At what age do nasolabial folds start to appear?

    From the age of 40 onwards, important components of the skin, such as collagen, hyaluronic acid and elastin, decrease. In fair-skinned people, increased UV radiation and cigarette smoking, wrinkles develop as early as age 30 [1]. The depth and length of the nasolabial folds have a major impact on age estimation [2]. They are difficult to conceal with make-up. Nasolabial folds are one of the most frequently treated facial regions with fillers. A scientific study suggests that after injections of hyaluronic acid of the nasolabial folds, the affected persons appeared more attractive, more successful, more athletic and more self-confident [3].

    How are nasolabial folds injected?

    The entire anti-aging wrinkle injection takes about 30 to 45 minutes. For your comfort, a topical anesthetic cream will be applied before you have your nasolabial fold injected. If necessary, a targeted local anaesthetic of the upper lip can also be administered during the procedure by means of an injection with an appropriate active substance. The skin is surgically disinfected. The treatment is carried out under the strictest hygienic regulations. Depending on the depth of the wrinkle and the thickness of the skin, a hyaluronic acid gel with a moderate firmness (high modulus of elasticity) that is injected deeply is suitable. For more discreet nasolabial folds or as a supplement for deep wrinkles, a more liquid hyaluron gel is injected superficially (in the uppermost layers of the skin). This is how the nasolabial fold can be reduced or removed. Choosing the right hyaluronic acid and injecting it with the right technique are crucial for good results. When creating a treatment plan for the desired result, the corners of the mouth should be taken into consideration. A profound knowledge of the anatomy is important and necessary in order not to injure the facial artery (Arteria facialis), which is located below the nasolabial fold. The facial artery takes a tortuous course about an inch to the side of the corner of the mouth to the base of the nose. Near the nostril, the facial artery is located just below the skin. In order to prevent reddening of the skin, a possible slight swelling or bruising with bruises or to make them disappear, you will be given a cooling pad after the wrinkle injection.

    How many milliliters of hyaluronic acid per nasolabial fold?

    For the treatment of a not too pronounced nasolabial fold, small amounts of hyaluron are injected per side, in about 0.5 to 1 millilitre, depending on the length and depth of the fold. Through the tightening or lifting effect of an injection on the cheek, the nasolabial fold can be further smoothed and a youthful cheek contour can be formed. After an initial treatment, further treatments can be arranged in more pronounced cases. The amount of filler needed should always be based on the treatment plan. The answers to other common questions regarding the amount of hyaluronic acid applied can also be found in advance on our page Filler – everything you need to know. Precise planning is important before each injection and will be discussed with you during the consultation. In this conversation we will of course also address your individual questions on the subject.

    Is injecting the nasolabial fold on only one side useful?

    In some cases, people may develop a nasolabial fold on one side and thus a drooping corner of the mouth. This occurs, for example, in the case of partial fascial paresis, including after a stroke. Here it can be advantageous or even sensible to inject the wrinkle on one side only in order to achieve the desired effect on one side only and thus restore symmetry. Alternatively, the treating physician can apply different amounts on both sides. This example illustrates the need for high-quality training of specialists in aesthetic medicine. Always choose plastic and cosmetic surgery experts who have many years of proven professional experience. Only in the hands of experienced doctors can you be absolutely certain that the anatomy of your face is precisely known and that correct action will be taken even in the event of unexpected complications.

    How long does the injection of nasolabial folds last?

    Fillers are broken down by the body through oxygen radicals and the enzyme hyaluronidase. Our skin on the face is exposed to frequent movements. This allows the degradation to occur more quickly and the visible effect to wear off more quickly. The duration of the effect depends on the amount injected and the type of hyaluronic acid. The smoothing of the nasolabial fold lasts 6 to 12 months.

    Cost of nasolabial fold injections

    Before a first hyaluronic injections is an examination, the education and the creation of a treatment plan essential. In the course of the interview you will receive an offer. You can find more information about the consultation here. The costs of wrinkle injections are calculated on the basis of the effort and the amount of hyaluronic acid used. You can find an order of magnitude of the prices in advance for orientation on our cost page.

    Is the treatment of the nasolabial fold with filler sufficient?

    In the case of a very pronounced nasolabial fold, it is possible to combine injecting with hyaluronic acid with other techniques without surgery. First, however, it can be analyzed which amount of hyaluron is appropriate in your case. In some cases, it makes sense, for example, to also perform an injection on the cheeks, as this simulates a lift. In this way, the corners of the mouth are additionally lifted.

    In addition, there are of course several different methods and active ingredients to achieve a youthful appearance. Each case must be assessed individually to determine whether a combination makes sense. Micro-needling with a narrow derma roller or the use of a derma pen for precise treatments on smaller areas can also help your skin. In addition, there are skin boosters, therapy with the body’s own blood or, in cases of particularly pronounced wrinkles between the mouth and nose, even surgical procedures or measures can be recommended to regain a young appearance. However, an immediately visible result is only given by the minimally invasive wrinkle injection with hyaluron filler. It is the most effective method. This makes these fillers from renowned manufacturers so popular. To receive an individualized treatment plan tailored to your needs and desires, simply schedule a personal on-site consultation.

    What are the risks?

    If you are having your nasolabial folds injected, you are probably wondering about the risks, side effects and possible allergic reactions. In any case, you should seek the advice and treatment of a qualified and experienced doctor who also attaches great importance to the careful selection of the appropriate and correct hyaluronic acid. This ensures safe treatment. The risks are increased when used improperly by non-qualified persons. High-quality products are just as important as expert application of the method. Too much volume, a too firm hyaluronic acid or a very superficial hyaluronic treatment can lead to irregularities. Rarely, the injected hyaluronic acid can be displaced to another location by the movement of the facial muscles. In rare cases, the hyaluron can find its way into the bloodstream and block a vessel. The risk is between 0.05 and 0.001 percent [4]. The cells in the end-stream pathway then suffer an oxygen deficiency and die. The first signs of this are severe pain, a change in skin color, swelling, or visual field restrictions. In this case, you must contact your doctor immediately. Particular care should be taken if the blood supply to the tissue has been altered by previous operations.

    Your safety is our top priority

    Ten reasons why you are in safe hands with us:

    • Dr. Santos Stahl has a detailed knowledge of the anatomy of the face and many years of experience.
    • With great sensitivity, we always check whether a vessel has been injured before injection.
    • The fillers are injected gently and with little pressure.
    • Only atraumatic and high-quality hollow needles are used.
    • During and after the treatment, the tissue is carefully observed.
    • We always keep an up-to-date and tested emergency equipment in order to be able to react immediately
    • We follow protocols in case of emergency according to current guidelines.
    • Our patients are well educated and know what to look for
    • Dr. Santos Stahl can also be reached by phone after treatment in case of emergency.
    • On the occasion of a follow-up appointment we make sure of the satisfaction and well-being of our patients.

    What can you do to ensure safe treatment?

    Ask about the training and experience of the doctor you are confiding in. Do not attempt to inject yourself with hyaluronic acid. Without a thorough knowledge of the anatomy of the facial muscles, nerves and blood vessels, the treatment can be very dangerous. You may suffer permanent scarring, paralysis or blindness. Without surgical disinfection, there is a risk of severe inflammation. The U.S. Food & Drugs Administration has therefore also established strict rules. Only approved fillers may be used by qualified physicians for specific applications. The health authority emphasizes, “Filler injections are a medical procedure, not a cosmetic treatment.”

    Testimonials for nasolabial fold injections

    Before patients decide on an appropriate treatment and choose a suitable experienced expert for the treatment, they usually search the Internet for testimonials. People who have already used the treatment at the respective practice explain in such reports whether they were satisfied with the service, the consultation and of course with the treatment and the result of their appearance. Patient testimonials can be quite helpful. Ratings additionally provide an average overall picture of patient satisfaction. Therefore, visit our corresponding page, which bundles all this.

    Before and after pictures of nasolabial fold injections

    Before patients decide to undergo non-surgical treatment for nasolabial folds and thus lift the corners of the mouth, they often want to see before-and-after pictures of treatments the practice has performed. Centerplast also offers the possibility of having treatment results shown. You can find more information about this on our corresponding page.

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    The author

    Dr. Adelana Santos Stahl

    “Our goal is to provide the best, most discreet and precise treatment based on our extensive expertise in plastic surgery. „

    Dr. Adelana Santos Stahl is distinguished by a unique international perspective with a feminine view of plastic surgery. Her personalized and detailed approach is key to the beautiful and natural results she achieves. Having trained in Brazil, one of the largest and most well-known countries for aesthetic and reconstructive plastic surgery, she understands her patients’ desire to look and feel their best.She completed her medical studies and her training as a specialist for plastic and aesthetic surgery in Brazil. In 2009, she also successfully passed the German equivalence examinations for the medical state examination. Two years later, in 2011 she received the German and in 2012 the EU specialist recognition (EBOPRAS) for plastic surgery.From 2009 to 2013, she deepened her knowledge of aesthetic and reconstructive facial surgery with world-renowned representatives of plastic surgery such as Professor Gubisch at the Marienhospital and Madame Firmin in Paris.A VDÄPC Fellowship (continuing fellowship for graduate students) in Switzerland, France and the USA has further enriched her professional experience.Dr. Santos Stahl is active in several prestigious professional societies. Besides the DGPRÄC and DGBT, she is also a member of the Brazilian Society of Plastic Surgery – SBCP.She is also the author of several scientific articles and, together with her husband, is dedicated to research and clinical studies in the field of plastic surgery.

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