Nasolabial Fold Filler Technique: Natural Rejuvenation

Medically Reviewed
Medically Reviewed by Dr. Aurora Kalmanson on
Written by Fillers Editorial Team, plastic surgery specialists.

Nasolabial fold fillers are a cosmetic treatment aimed at reducing the appearance of smile lines that extend from the nose to the corners of the mouth. With advancements in dermal filler technology, various techniques and products are available to address these signs of aging.

The choice of filler—temporary or semi-permanent—depends on individual needs and the desired duration of effect. FDA-approved fillers offer safety and efficacy, with considerations such as particle elasticity and symmetry playing a crucial role in achieving natural-looking results. Techniques for filler injection are refined to minimize risks, with a focus on avoiding arterial injection and ensuring a smooth, rejuvenated appearance.

Nasolabial Fold Filler Techniques

Mastering nasolabial fold filler techniques is crucial for achieving a natural and rejuvenated appearance while minimizing risks. Various approaches, each with their nuances, serve to the diverse needs of patients and the complexity of the facial anatomy.

Injection Approaches

Multilayered Injection Technique (Anesthetizing the Entry Point): The multilayered injection technique begins with anesthetizing the entry point to ensure patient comfort. This approach involves injecting fillers at various depths to create a more structured and lasting effect. Initially, a deeper layer is targeted to provide foundational support, often near the bone or deep subcutaneous tissue. Subsequent layers are then added more superficially, allowing for a nuanced correction that respects the natural contours of the face. This technique can address both the depth of the folds and the surface texture, resulting in a smoother and more youthful appearance.

Linear Threading and Fanning Techniques: Linear threading involves the insertion of filler along a line within the nasolabial fold, depositing the product as the needle is withdrawn. This method allows for a precise application and is effective for defining the edge of the fold. Fanning, on the other hand, involves multiple injections from a single entry point, with the filler being laid down in a fan-like pattern. This technique is beneficial for covering a larger area and providing a more even distribution of the filler. Both methods require skill and an understanding of the facial anatomy to achieve the desired lift and volume without overcorrection.

Cannula vs. Needle Use (Use of Blunt Tipped Cannulas): The choice between using a cannula or a needle for filler injections is significant. Cannulas, with their blunt tips, are less likely to puncture blood vessels, reducing the risk of bruising and vascular complications. They allow for a smoother delivery of the filler and can be particularly useful when treating delicate areas like the nasolabial folds. Needles, being sharper, offer more precision but carry a higher risk of injury to the tissues. The decision to use a cannula or needle will depend on the practitioner’s expertise, the specific area being treated, and the desired outcome of the procedure.

Avoiding Complications

Understanding Vascular Anatomy (Facial Artery Proximity and Risks): A thorough understanding of the vascular anatomy is vital to avoid complications during nasolabial fold filler injections. The facial artery, which runs close to the nasolabial folds, poses a risk for accidental intravascular filler injection, which can lead to serious complications such as skin necrosis or even blindness. Knowledge of the artery’s typical pathway and its variations among individuals is crucial for safe injection practices. Practitioners must be adept at identifying the signs of vascular compromise and be prepared with emergency protocols, including the use of hyaluronidase, an enzyme that can dissolve hyaluronic acid-based fillers in the event of an arterial occlusion.

Avoiding Arterial Injection (Precautions and Safe Injection Practices): To prevent arterial injection during nasolabial fold treatments, practitioners must stick to strict safety protocols. This includes thorough knowledge of facial anatomy, careful palpation of the pulse, and the use of aspiration before injecting the filler. Aspiration is a technique where the clinician pulls back on the syringe plunger to check for blood return, which can indicate intravascular needle placement. Additionally, using small amounts of filler per injection site and injecting slowly can reduce the risk of arterial occlusion. It is also advisable to use blunt-tipped cannulas instead of needles in high-risk areas to minimize the chance of penetrating a blood vessel.

Managing Complications (Recognizing Vascular Occlusion and Emergency Protocols): Recognizing the early signs of vascular occlusion is critical in managing complications from filler injections. Indicators such as immediate blanching of the skin, pain, or changes in skin color should alert the practitioner to stop the procedure and assess the situation. Emergency protocols include the administration of hyaluronidase to dissolve hyaluronic acid-based fillers and restore blood flow. Other measures include warm compresses, massage, and, if necessary, referral to a specialist. Practitioners should have an emergency kit readily available and be trained in its use to respond quickly to any adverse events.

Best Practices and Safety Measures

Injection Safety and Efficacy

Aspiration Technique and Its Importance: The aspiration technique is a critical safety measure in the administration of dermal fillers. By gently pulling back on the syringe plunger after needle insertion, practitioners can check for blood in the needle tip, which would indicate intravascular placement. This simple step significantly reduces the risk of injecting filler into a blood vessel, which can lead to serious complications such as vascular occlusion or embolism. Although aspiration is not foolproof and may not always detect needle placement in smaller vessels, it remains a widely recommended practice for enhancing patient safety during filler injections.

Slow Injection Method and Monitoring: The slow injection method is a key practice for enhancing the safety and efficacy of dermal filler treatments. By administering the filler gradually, practitioners can better control the placement and amount of product, reducing the likelihood of overcorrection and minimizing the risk of pressure-induced vascular compromise. Continuous monitoring during the injection allows for immediate identification and management of any adverse reactions, such as pain or changes in skin coloration, which could signal an impending complication. This vigilant approach ensures a more controlled and precise treatment, leading to better outcomes and higher patient satisfaction.

Frequently Asked Questions

How do I know if nasolabial fold fillers are right for me?

Nasolabial fold fillers may be suitable if you're looking to reduce the appearance of smile lines and have realistic expectations about the results. Consultation with a qualified practitioner is essential.

Can nasolabial fold fillers be reversed if I'm not satisfied with the results?

Yes, hyaluronic acid-based fillers can often be dissolved with an enzyme called hyaluronidase.

How long do the results of nasolabial fold fillers typically last?

Results can last from 6 months to over a year, depending on the type of filler used and individual factors.

Are there any activities I should avoid after getting nasolabial fold fillers?

Avoid strenuous exercise, excessive heat, and sun exposure for at least 24-48 hours post-treatment.

What are the risks associated with nasolabial fold filler injections?

Risks include bruising, swelling, infection, and more rarely, vascular occlusion or allergic reactions.

Can nasolabial fold fillers be reversed if complications arise?

Yes, complications from hyaluronic acid fillers can often be managed with hyaluronidase injections.

What should I do if I experience pain or discoloration after the procedure?

Contact your practitioner immediately as this could indicate a complication that needs prompt attention.

Are there non-invasive alternatives to nasolabial fold fillers?

Yes, options include topical treatments, laser therapy, and radiofrequency treatments, although results may be less dramatic.


Nasolabial fold fillers offer a dynamic solution for those seeking to diminish the signs of aging around the mouth. With a range of techniques and products available, it's crucial to understand the potential risks and the importance of practitioner expertise. Proper patient assessment, customized treatment plans, and stick to safety protocols are key to successful outcomes. As with any cosmetic procedure, thorough research and consultation with a qualified professional are advised to ensure that nasolabial fold fillers align with your aesthetic goals and health considerations.

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Stefura, T., Kacprzyk, A., Droś, J., Krzysztofik, M., Skomarovska, O., Fijałkowska, M., & Koziej, M. (2021). Tissue Fillers for the Nasolabial Fold Area: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Yi, K. H., Lee, J. J., Hur, H. W., Bae, H., & Kim, H. J. (2022). Hyaluronic acid filler injection for deep nasolabial folds: A novel intraoral approach.

Lee, W., & Yang, E. J. (2022). Hyaluronic Acid Filler Injection Technique in Multiple Layers of the Nasolabial Fold.

Dr. Aurora Kalmanson

Always Consult a Medical Specialist

The information provided in this blog is for informational and educational purposes only and should not be interpreted as personalized medical advice. It's crucial to understand that while we are medical professionals, the insights and advice we provide are based on general research and studies. They are not tailored to individual health needs or conditions. Thus, it is essential to consult directly with a healthcare provider who can offer personalized medical advice relevant to your specific situation.