If you've spent time researching nasolabial folds — those lines that run from the sides of your nose down to the corners of your mouth — you've probably come across two very different treatment paths: lifting and volume replacement. They're not the same thing, and choosing the wrong one won't just waste money; it can leave you looking worse than when you started.

In this article, we'll cover what actually causes nasolabial folds, what lifting can and can't fix, when adding volume is the smarter move, and how a board-certified dermatologist approaches this decision. Read on.

What Causes Nasolabial Folds?

The short answer? It's almost never just one thing. Nasolabial folds deepen for several overlapping reasons:

• Skin laxity: As collagen and elastin break down with age, skin loses its ability to spring back — it begins to droop, and that droop lands right along the nasolabial crease.

• Volume loss: The mid-face is supported by a scaffolding of fat pads. When those fat compartments shrink (which they do, gradually, from your late 20s onward), the skin above them deflates. The fold doesn't just look deeper — the cheek itself looks flatter.

• Bone resorption: The facial skeleton changes with age too. Studies suggest that the maxilla (upper jaw bone) recedes over time, reducing the structural support for overlying soft tissue. Individual results vary depending on genetics and lifestyle.

• Repetitive muscle movement: Smiling, chewing, and talking all create dynamic stress along the nasolabial crease, gradually etching the line more permanently into the skin.

Understanding which of these factors is dominant in your face is the whole ballgame. A treatment that's excellent for one cause can be completely ineffective — or actively counterproductive — for another.

What Can Lifting Actually Do?

Lifting, whether via HIFU (high-intensity focused ultrasound), radiofrequency, or thread techniques, works by stimulating collagen remodeling and, in some cases, physically repositioning tissue. Here's what the research supports:

Where lifting excels: When the primary driver of your nasolabial fold is descended tissue — cheek fat pads that have migrated downward, skin that's lost its anchor — lifting can genuinely move things back toward where they belong. Studies indicate that HIFU-based treatments targeting the SMAS (superficial musculoaponeurotic system) can produce measurable elevation of the mid-face and softening of the nasolabial fold in patients with predominant laxity. A 2017 review in the Journal of Cutaneous and Aesthetic Surgery notes that focused ultrasound produces contraction of collagen fibers and neocollagenesis at targeted depths.

Where lifting falls short: If the cheek is deflated — meaning the fat volume is simply gone, not just low — lifting won't refill it. In fact, tightening already-thin skin over an empty scaffold can sometimes accentuate hollows. This is where the look that people associate with overdone procedures actually comes from. It's not that lifting was done badly; it's that lifting was done when volume was the actual problem.

The honest clinical reality, supported by emerging research on facial aging patterns, is that most patients in their 40s and older have both laxity and volume loss happening at the same time. Treating only one seldom delivers the result people are hoping for.

When Volume Is the Right Answer

There are a few signs that suggest your nasolabial fold is primarily a volume problem, not a laxity problem:

• The pinch test: Gently pinch the skin over your cheekbone. If it feels thin and there's relatively little to grab, volume loss is likely a significant factor.

• Flat or hollowed mid-face: If you notice that your cheeks look deflated or the area under the cheekbones looks sunken, that's a classic sign of fat pad atrophy — a problem lifting won't reverse.

• The fold deepens with weight loss: Rapid or significant weight loss accelerates fat pad shrinkage. Lifting can't address the structural deficit this creates.

• You're in your late 30s or 40s: This is when volume loss typically starts to become clinically visible alongside laxity. It's rarely just one issue at this stage.

In these scenarios, volume restoration is the primary need. Options include hyaluronic acid dermal fillers, poly-L-lactic acid (PLLA) collagen stimulators like Sculptra, and PDLLA-based biostimulators like Juvelook or Juvelook Volume. Research published in a 2025 review on injectable aesthetics supports the use of mid-face volume restoration as a foundational approach before or alongside lifting in patients showing both concerns.

It's important to note: adding volume to a nasolabial fold doesn't mean injecting directly into the fold line itself. Most dermatologists prefer to restore cheek volume above the fold — essentially re-inflating the scaffold — and allow the fold to soften naturally as a result. Direct fold injection, while sometimes used, carries a higher risk of vascular complications and tends to produce an unnatural-looking result when overdone. Individual results vary.

The Case for Combining Both

In clinical practice, the most common scenario for patients in their mid-40s and beyond isn't volume OR lifting — it's volume AND lifting, sequenced thoughtfully.

The typical approach looks something like this:

• Step 1 — Restore volume: Address deflation first. Once the structural scaffold is rebuilt, the skin has something to sit on properly.

• Step 2 — Lift the tissue: After volume is restored, a lifting treatment (HIFU, RF, or thread) can then address any remaining laxity and refine the result.

• Timing matters: Doing a very aggressive lifting treatment immediately after filler placement isn't ideal — the heat or mechanical force can displace freshly injected material. Your provider will typically space these by a few weeks, or recommend starting with lifting if the volume deficit is modest.

This combined approach is well-supported by the literature. A study in Aesthetic Surgery Journal emphasizes that restoring the anatomical proportions of the mid-face — not just tightening overlying skin — produces more natural and durable results. Individual results vary, and what works for one face doesn't automatically apply to another.

Side Effects and Risks to Know

Whether you pursue lifting, volume restoration, or a combination, it's important to understand what you're signing up for. Here's a realistic overview:

Lifting procedures (HIFU, RF, threads):

• Temporary redness and swelling: Common after treatment; typically resolves within a few days.

• Nerve sensitivity or numbness: More common with HIFU; usually resolves within weeks to a few months.

• Surface irregularities with threads: Thread lifting carries risk of palpable threads, dimpling, or asymmetry if placement isn't precise.

• Worsening hollowness: This happens specifically when lifting is done on a face that needed volume first. It's a treatment selection issue, not a procedural complication.

Volume restoration (fillers and biostimulators):

• Bruising and swelling: Very common post-injection; usually settles within a few days to a week.

• Vascular occlusion: A rare but serious risk, particularly with direct fold injection. Symptoms include blanching, severe pain, or mottled skin following injection. If you notice spreading redness, severe pain, skin color changes, or vision changes after any injectable procedure, seek medical care right away.

• Nodules or granulomas: More common with PLLA and PDLLA biostimulators, particularly if dilution and massage protocols aren't followed carefully.

• Asymmetry: Some asymmetry is normal short-term; persistent asymmetry may require a touch-up or, with HA fillers, hyaluronidase correction.

Like any procedure, both categories come with trade-offs. The best way to minimize risk is to work with a provider who identifies the structural cause of your concern before recommending a treatment — rather than defaulting to what's currently on promotion.

How to Tell Which One You Need

This is the question most people actually want answered. There's no substitute for an in-person assessment, but here's the framework a dermatologist will typically use:

Mirror test: Look straight ahead in a well-lit mirror. Then tilt your head slightly back. If the fold looks noticeably softer when your face is upright but deeper when you look down, that's often a sign of descended tissue — laxity is a significant driver. If the fold looks similar regardless of head position, deflation may be dominant.

Finger lift test: Gently place two fingers at the top of your cheekbone and lift the skin upward. If the nasolabial fold largely disappears, lifting has real potential. If the fold persists or the cheek still looks hollow, volume replacement is likely needed first.

Age and weight history: Younger patients (under 40) with early fold formation tend to have primarily laxity. Patients who've lost significant weight, or those 45 and older, frequently have significant volume loss alongside whatever laxity is present.

These self-assessments are rough guides — not diagnostic tools. A board-certified dermatologist can evaluate tissue depth, fat pad volume, skin quality, and structural support with an accuracy no mirror test can match.

The Bottom Line

Here's what's worth taking away from all of this:

• Nasolabial folds are caused by a combination of skin laxity, volume loss, and structural bone changes — and most people in their 40s and beyond have all three happening at once.

• Lifting works well when descended tissue is the primary driver. It won't refill deflated fat pads — and applied to a hollow face, it can make hollowing more visible.

• Volume restoration (fillers, Sculptra, Juvelook) addresses the structural deficit that lifting can't fix. In many patients, volume first and lift second is the most effective sequence.

• The combination approach — volume plus lifting, appropriately timed — tends to produce the most natural and lasting outcomes for patients with moderate-to-significant fold depth.

Ultimately, the right path depends on your anatomy, your age, your history, and your goals. There is no one-size-fits-all answer.

If you're considering treatment for nasolabial folds or perioral sagging, a consultation is genuinely the most useful first step. Beautystone is a dermatology clinic in Seoul's Hapjeong area. You can see current offers at /en/promotion.

Frequently Asked Questions

Q. Can lifting alone fix deep nasolabial folds?

A. It depends on the cause. If the folds are driven primarily by descended tissue and skin laxity, lifting can produce meaningful improvement. But if the deeper issue is mid-face volume loss, lifting alone won't refill the structural deficit — and may actually make hollowing more visible. Most patients over 40 benefit from a combination of volume restoration and lifting.

Q. Which is better for nasolabial folds — filler or HIFU?

A. They solve different problems, so 'better' isn't quite the right frame. Filler addresses deflation; HIFU addresses descended tissue and skin laxity. When both issues are present — which is common in patients in their 40s and beyond — a sequenced combination tends to produce the most natural result. Individual results vary.

Q. How much does nasolabial fold treatment cost?

A. Cost varies considerably depending on which treatment or combination is appropriate for your anatomy. Because nasolabial fold treatment is highly individualized, exact pricing is best confirmed after a consultation. You can see current offers at /en/promotion. Seoul clinic pricing is subject to change.

Q. Is filler for nasolabial folds safe?

A. When performed by an experienced provider, dermal filler for the nasolabial area is generally considered safe. The primary serious risk is vascular occlusion — a rare complication that's more likely with direct fold injection than with cheek-level volume restoration. If you experience blanching, severe pain, or any vision changes after injection, seek medical care immediately.