Nasolabial fold filler in Wiesbaden — with the whole midface in view

Why the nasolabial fold develops

The nasolabial fold is not a wrinkle in the sense of creased skin, but a boundary between two tissue zones: above it lies the mobile cheek with its fat pads, below it the more firmly anchored upper lip. Even children have this line when they laugh. That it also remains visible at rest over the years has three main causes. First, the deep fat compartments of the cheek lose volume, and the bone of the upper jaw and cheekbone recedes slightly — the cheek sinks downwards and inwards and folds over the line. Second, the skin's elasticity declines, so the descended tissue no longer springs back. Third, facial movement — laughing, speaking, chewing — reinforces the line thousands of times a day. Because the cause is volume loss and not muscle activity, botulinum toxin does not help here; the appropriate agent is hyaluronic acid.

Why we rarely fill only the fold

Injecting hyaluronic acid only into the groove raises the base of the fold — the fold looks flatter, but the cheek above it remains sagged. With more pronounced folds this creates an uneven, “filled-up” impression, and when smiling the material bulges outwards. That is why a good treatment usually begins one level higher: a few deposits of a firmer filler on the cheekbone and in the deep cheek fat support the midface, the tissue is gently lifted, and the nasolabial fold flattens indirectly. Only afterwards, if still necessary, is a soft filler placed directly into what remains of the fold. The result is calmer, lasts longer and overall often needs less material than simply filling. How we contour cheeks and cheekbones is described under jawline, chin and cheeks in Wiesbaden.

Nasolabial fold and marionette lines — two lines, one connection

The nasolabial fold has a continuation: in many people, a second line runs downwards from the corner of the mouth to the chin, the so-called marionette line. Both arise from the same movement of the tissue — the midface descends, and the lower face collects what is lost above. That is why we also look at the corners of the mouth with every nasolabial treatment. If the marionette line pulls the corners of the mouth downwards, the expression still looks stern despite a smoothed nasolabial fold; then it makes more sense to treat both zones together, each with restraint, than to fill one of them completely.

When is the right time?

There is no age at which a nasolabial fold “must be treated”. As long as the line appears only when you smile, it is expression, not a finding. Treatment usually becomes sensible when the fold remains visible at rest, casts a shadow or is perceived as tired or stern — for many people between their late thirties and mid-fifties, for others earlier or later. Equally honest is what hyaluronic acid cannot do: severely slackened, crinkled skin above the fold does not become firmer through volume, and a pronounced sagging of the entire lower face can only be compensated to a limited extent with filler. In such cases we discuss openly which other procedures might be considered. A second opinion after a treatment elsewhere is also welcome with us.

How the treatment works

Amount, price and duration

For the nasolabial folds alone, one millilitre is often enough, divided between both sides. If the midface is supported as well, one to two millilitres are usually added. Treatment of the nasolabial folds is generally between €350 and €600; for the cheeks, allow an additional €400 to €800, depending on the amount. All prices include 19% VAT, are billed according to the German medical fee schedule (GOÄ), and are set out in writing before the treatment. Because the nasolabial region moves less than the lips, hyaluronic acid here usually lasts twelve months and often longer; a deeply placed cheek filler generally remains effective for twelve to eighteen months.

Risks and limits

Swelling, redness and small bruises are normal after the injection and subside within a few days; they can be covered with make-up from the following day. Also possible are slight asymmetries, palpable small nodules or a temporarily fuller impression when smiling. In the nasolabial region, the facial artery runs close beneath the skin — which is why we prefer to work here with a blunt cannula and in small portions. Should filler nevertheless enter a vessel, which is very rare, it is immediately dissolved by a doctor with hyaluronidase (Hylase). We do not treat during pregnancy and breastfeeding or in the case of acute infection or herpes on the face. An honest conversation also includes this: a deep nasolabial fold can be softened, not erased — a certain amount of relief is part of a living face. What you should bear in mind after treatment can be found in the aftercare for fillers.

Alternatives and complements

• Collagen stimulation — stimulates the skin's own collagen production and can be a complement when firmness in the midface is declining. More under collagen stimulation.
• Skin booster — non-cross-linked hyaluronic acid for moisture and skin quality; useful when the skin above the fold is crepey, but not as a volume replacement. See Skin booster in Wiesbaden.
• Combination with other zones — the face often looks more harmonious when marionette lines or the chin are also taken into account. The main page hyaluronic acid fillers in Wiesbaden gives an overview.

Related pages

• Hyaluronic acid fillers in Wiesbaden — overview
• Contouring jawline, chin & cheeks
• Tear trough filler
• Lip augmentation
• Skin booster
• Hyaluronidase (Hylase) — dissolving filler
• Hyaluronic acid for Mainz
• Hyaluronic acid fillers for Frankfurt
• Guide: What does hyaluronic acid filler cost?
• Guide: How long does hyaluronic acid filler last?
• Guide: side effects and risks
• Guide: Hyaluronic acid filler or skin booster?
• Aftercare after filler

Read more in the guide

• What does hyaluronic acid filler cost in Wiesbaden?
• How long does hyaluronic acid last?
• Hyaluronic acid: side effects and risks honestly explained

Frequently asked questions