Unit 11: Nasolabial Fold


When treating the nasolabial fold, you should understand how to prevent and recognise as well as treat serious complications of impending alar necrosis.


The nasolabial fold is present from birth, but as we age this becomes longer and deeper. The deepening of these lines is one of the first signs of ageing.

When we smile the action of the zygomatic muscles accentuates the fold which over time impacts the surface of the skin where creases and fine lines appear. Upon treatment, the fold should still be present when we smile – overcorrection can lead to the patient looking unnatural.

The deepest part of the shadow is just inferior to the alar junction and a small shadow can be seen at this point. At this stage of training, the alar base should be avoided.

You will need to be aware of the lateral nasal artery branching from the angular artery as dermal filler placement near this artery can either compress the artery or cause necrosis if the ller is injected incorrectly.

Surface Anatomy

Before treatment you should examine the length and depth of the line as well as volume loss. Both features should be treated with their appropriate techniques.

Underlying Causes

Loss of volume under the skin

Superficial fat pad redistribution and volume loss

An increase in skin laxity due to ageing and sun damage

Rapid or significant weight loss

Desired Treatment Outcomes

Removes the shadows in the mid face

Elevates the cheek slightly

Widens the mouth slightly

Choice of Filler

Medium viscosity  fillers

Common site-specific side effects


Asymmetry which is usually pre-existing

Common injection techniques

Volume Loss

  1. Fanning – to spread the volume evenly
  2.  Layering – for severe volume loss and to spread the filler evenly

Surface Creases

Cross-hatching – for more resistant  fine lines

Serial Puncture – Suitable for fine surface lines


There are no recommended volumes as every client will have varying needs.

Superficial creases with a minimal loss of volume may only require 0.3-0.6mls of ller where very deep lines that need more advanced techniques may require 2-4mls.

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