Nasolabial Folds: Why It’s Volume, Not a Wrinkle

The main driver is loss of volume in the deep cheek fat compartment that sits nearest the fold, as this deflates, the skin covering it has less support underneath, and the fixed boundary line beside it becomes a visible crease rather than a smooth transition.

Contributing factors include:

• Age-related fat loss: the deep midface compartments lose volume gradually from the late 20s onward for most people, more noticeably in midlife.
• Skin laxity: reduced collagen and elastin mean the skin over the fold supports itself less well.
• Genetics and facial structure: some faces show a more visible fold at a younger age purely from bone and fat-compartment anatomy.
• Weight change: significant weight loss can unmask deep volume loss that was previously hidden by more fat.

Nasolabial folds of some degree are normal at almost any age, even younger faces show a faint line here, because it is a genuine anatomical boundary, not purely a sign of ageing. What changes with age is how deep and shadowed that line becomes.

The nasolabial fold is one of the highest-risk sites on the face for filler injection. This needs to be stated plainly rather than glossed over. A world-literature review of documented vision-loss cases following filler injection found the nasolabial fold to be the third most commonly implicated site, behind only the area between the eyebrows and the nose itself: accounting for roughly one in eight of the cases reviewed.

The reason is anatomical: this region carries a dense, individually variable network of facial and infraorbital artery branches, and these vessels connect, through a chain of anastomoses, to the arteries supplying the eye. Injecting filler directly into one of these vessels (rather than the surrounding tissue) is a rare but genuine cause of sudden, often permanent vision loss.

This is precisely why nasolabial fold filler should only ever be performed by an appropriately trained medical injector who understands this vascular anatomy, uses technique that reduces (though never fully eliminates) the risk, and has hyaluronidase (the enzyme that dissolves hyaluronic acid filler) immediately available in case of a vascular event.

Overcorrection is a real, documented risk too. Filling this area too aggressively, or too often over time, can produce an unnatural, heavy-cheeked look (sometimes called “overfilled syndrome”) and, ironically, can worsen rather than soften the appearance of ageing in the lower face. Visible lumps or a blue-grey discolouration under the skin can also occur if filler is placed too superficially; both are correctable, usually with hyaluronidase, but are far easier to avoid with careful technique from the outset.