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, important components of the skin decrease, such as collagen, hyaluronic acid and elastin. In fair-skinned people, increased UV radiation and cigarette smoking, wrinkles develop as early as age 30 (Green AC., et al, 2011, Dermatology. 2011). The depth and length of nasolabial folds have a major impact on age estimation (Fang RY, et al., 2020, J Cosmet Dermatol). Therefore, nasolabial folds are among the most frequently treated facial regions with fillers. A scientific study suggests that after injecting hyaluronic acid into the nasolabial folds, those affected appeared more attractive, successful, athletic and self-confident (Dayan S.H., et al., 2010, Dermatol Surg.).

 

How are nasolabial folds injected?

The whole treatment lasts about 30-45 minutes. For your comfort, a numbing cream is applied before the treatment. If needed, additional targeted anesthesia can be applied to the upper lip using an anesthetic injection. The skin is surgically disinfected. The treatment is performed under the strictest hygienic regulations. Depending on the depth of the wrinkle and the thickness of the skin, hyaluronic acid with a moderate strength (high modulus of elasticity), which is deeply injected, is suitable. In case of more discreet nasolabial folds or supplementing deep wrinkles, a more liquid hyaluronic acid is injected superficially. Choosing the appropriate hyaluronic acid and injecting it in the right technique are crucial for a beautiful result. The corners of the mouth should be taken into consideration when creating a treatment plan. A profound knowledge of the anatomy is important to avoid injuring the facial artery, 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 nostril. Near the nostril, the facial artery is located just below the skin. To prevent bruising and redness of the skin, you will be given a cooling pad after the treatment.

 

How many milliliters of hyaluronic acid per nasolabial fold?

For the treatment of the nasolabial fold, about 0.5 to 1 milliliter of hyaluronic acid is injected per side, depending on the length and depth of the fold. Due to the tightening or lifting effect of an injection on the cheek, the nasolabial fold can be further reduced and a youthful cheek contour can be restored. The amount of filler required should therefore depend on the treatment plan. Precise planning is important before any injections and will be discussed with you during the consultation.

 

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, e.g. after a stroke. In this case, it may be useful to inject the wrinkle on one side only in order to restore symmetry.

 

How long does the injection of nasolabial folds last?

Fillers are degraded by oxygen radicals and the enzyme hyaluronidase. In facial regions that are exposed to frequent movements, the degradation can be faster. 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 the first injection is performed, it is essential to have an examination, education and the preparation of a treatment plan. You can find more information about the consultation here. The cost of the treatment is calculated on the basis of the effort and the amount of hyaluronic acid injected. You can find an order of magnitude of the prices 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, active ingredients and each case must be considered individually to check whether a combination makes sense. Micro-needling with a narrow dermaroller or the use of a derma pen for precise treatments on smaller areas can also help with the nasolabial fold. In addition, skin boosters, autologous blood therapy or even surgical measures may be recommended in cases of particularly pronounced wrinkles between the mouth and nose. However, an immediately visible result is only given by hyaluronic acid. This is what makes this filler so popular. To receive an individual treatment plan tailored to your needs and wishes, simply arrange a personal consultation on site.

What are the risks?

Injection of appropriate hyaluronic acid is a safe treatment in the hands of an experienced and qualified physician. The risks are increased in case of improper application by non-qualified persons. High quality products are as important as expert injections. Too much volume, hyaluronic acid that is too firm, or very superficial injections can cause irregularities. Rarely, the filler can be displaced to another location by facial muscle movement. In rare cases, hyaluronic acid can find its way into the bloodstream and displace a vessel. The risk is between 0.05 and 0.001 percent (Beleznay K, et al. 2014, J Clin Aesthet Dermatol). The cells in the end-stream pathway then suffer a lack of oxygen and die. Signs of this include severe pain, a change in skin color, swelling, or visual field loss. In this case, you must contact your doctor immediately. Special caution is required 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:

  1. Dr. Santos Stahl has a detailed knowledge of the anatomy of the face and many years of experience
  2. With great sensitivity, we always check whether a vessel has been injured before injection
  3. The fillers are injected gently and with little pressure.
  4. Only atraumatic and high-quality hollow needles are used
  5. During and after the treatment, the tissue is carefully observed.
  6. We always keep an up-to-date and tested emergency equipment in order to be able to react immediately
  7. We follow protocols in case of emergency according to current guidelines
  8. Our patients are well educated and know what to look for
  9. Dr. Santos Stahl can also be reached by phone after treatment in case of emergency
  10. 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 the 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 corresponding practice explain in such reports whether they were satisfied with the service, the consultation and, of course, with the treatment and the result. Patient testimonials can be quite helpful. Reviews 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 on non-surgical treatment of the nasolabial fold and thus lifting the corners of the mouth, they often want to see before-and-after pictures of treatments that the practice has performed. Centerplast also offers the possibility of showing treatment results. You can find more information about it on our corresponding page.

 

Author's statement

Author: Stéphane Stahl, MD, PhD. There are no financial relationships with the pharmaceutical or medical device industries that could have influenced the above text. Any reproduction, even partial, is permitted for personal use only. All texts used on this website are protected by copyright.

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Your Centerplast team around PD Dr. Stéphane Stahl and dr. Adelana Santos Stahl is happy to advise you.

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