Nasolabial Folds Aren't Just a Skin Issue
Many people assume nasolabial folds are simply a matter of sagging skin. In reality, they result from changes across multiple layers of facial structure occurring simultaneously:
- Bone resorption — the bony structure that once supported facial tissue gradually thins
- Descent of deep and superficial fat — fat pads that once sat higher on the face shift downward due to gravity
- Loss of ligament strength — the ligaments that once anchored facial structure in place stretch and weaken
- Reduced tautness of the SMAS and facial muscles — the deep fascia and muscle layer that once stayed firm begins to loosen
- Loss of collagen and elastin in the skin — the skin itself deteriorates with age
The result is descending cheeks and progressively deeper nasolabial folds.
"I often explain to patients that nasolabial folds are like a house whose internal structure has settled — not just peeling paint on the walls. Correcting the problem properly requires understanding which layer of the face is actually affected."
Treatment Principles: Fill and Lift
Treating nasolabial folds generally follows two core approaches:
- Fill with dermal filler to replace lost volume from bone and fat descent
- Lift with thread lifting to reposition sagging cheek tissue back into place
Many patients benefit from combining both approaches, since volume loss and tissue sagging frequently occur together.
HA Filler: Immediate, Visible Results
Hyaluronic acid (HA) fillers such as Restylane, Juvederm, Belotero, Teosyal, and Revanesse are the most popular option for restoring volume to nasolabial folds.
Advantages:
- Immediate results after injection
- Reversible if adjustments are needed
- Easy to customize and shape
- Well-suited for first-time filler patients
Limitations:
- Lasts approximately 8–18 months, depending on the product and injection site
Non-HA Filler / Biostimulators: Stimulating Collagen for Longer-Lasting Results
This category focuses on stimulating the body's own collagen production, delivering gradual but longer-lasting results than HA. Categories include:
- PLLA (Poly-L-Lactic Acid): Sculptra, AestheFill
- PCL (Polycaprolactone): Ellansé
- PDLLA (Poly-D,L-Lactic Acid): Juvelook
- PN/Polynucleotide: Rejuran, Plinest, Nucleofill
- Hybrid Biostimulator: Karisma
The Role of the Zygomaticus Major and Zygomaticus Minor Muscles
These two muscles are key smile muscles, responsible for lifting the cheeks and corners of the mouth. As we age, it isn't just the muscles that change — the bone, fat, ligaments, and SMAS system all deteriorate together, reducing the support holding cheek tissue in place, causing it to descend and deepening the nasolabial fold.
"I want to emphasize this point — nasolabial folds aren't caused by muscle weakness alone. They result from multiple factors combined. Treatment that only addresses one angle often falls short of a complete result."
How Skin-Tightening Devices Can Help
Different skin-tightening devices work through different mechanisms:
- HIFU and RF focus on contracting existing collagen and stimulating new collagen production
- Emface uses RF combined with High-Intensity Facial Electrical Stimulation to directly strengthen and tone muscles such as the Zygomaticus Major and Zygomaticus Minor
As the muscle system becomes stronger, it helps support cheek tissue, making nasolabial folds appear shallower in patients with mild to moderate sagging. However, in cases of significant volume loss, filler or thread lifting may still be needed alongside device treatment for a complete result.
Summary
Nasolabial folds result from combined changes in bone, fat, ligaments, muscle, and skin — not from a single cause alone. Treatment selection should be based on each person's underlying cause:
- HA filler suits immediate volume restoration
- Non-HA filler/biostimulators suit long-term collagen stimulation and structural restoration
- Thread lift suits repositioning sagging cheek tissue
- Skin-tightening devices help strengthen skin and muscle, particularly in early-stage cases
The best treatment approach starts with a thorough individual assessment of what's causing your nasolabial folds, followed by selecting the appropriate combination of techniques. At Drema Clinic, we offer personalized consultations tailored to you. If you're dealing with nasolabial folds and want to understand what's causing yours, feel free to reach out for a chat.