Are Fillers Good for Nasolabial Folds? Options for Smile Lines

Are fillers good for nasolabial folds?

Yes, for many people. Correcting moderate to severe facial wrinkles and folds, such as nasolabial folds, is a long-standing FDA-approved use for dermal fillers. The realistic goal is a softer fold, not a flat cheek. The crease is part of normal facial anatomy, and it shows every time you smile.

The approvals go back more than two decades. FDA records show Restylane was approved in December 2003 for moderate to severe facial wrinkles and folds such as nasolabial folds, and Juvederm Ultra Plus XC is indicated for the same kind of correction. Two fillers that are not hyaluronic acid were also approved for folds: Radiesse, made of calcium hydroxylapatite, in 2006, and Sculptra Aesthetic, made of poly-L-lactic acid, in 2009, the latter for shallow to deep nasolabial fold contour deficiencies in people with a healthy immune system.

Trials show the effect is real but measured. In the 2006 FDA trial of Radiesse, 78.6% of treated folds scored at least 1 point better at 6 months than the opposite fold, which was treated with a collagen filler. In the trial behind Juvederm Ultra Plus, 90% of people kept their improvement at 24 weeks, compared with 40% on the collagen-treated side. Derm Clinic MD offers smile lines filler for nasolabial folds and marionette lines, and every plan starts with an in-person consultation.

Why do smile lines get deeper with age?

Nasolabial folds often deepen because the midface changes with age. A 2025 expert panel in Dermatologic Surgery described midface aging as a mix of bone remodeling, fat compartment loss and loosening ligaments, and noted that the pattern varies across ethnic groups. As cheek support changes, the fold beside the mouth often looks deeper.

Sun exposure adds to it. A 2026 genetic study of 4,421 young ethnic Chinese adults in Singapore and Malaysia found that regular sun exposure raised the odds of having nasolabial folds 1.26-fold, while skin types that tan easily had lower odds. That is one more reason to make daily sunscreen part of any plan for smile lines, through Atlanta summers and the rest of the year.

Genes matter too. The same study linked a variant near the SAMD5 gene to folds in sun-exposed young adults, and it found folds were common even in that young group. That may help explain why some people notice smile lines in their 20s and others much later. Because no single treatment addresses every cause, the first step is working out which cause is driving yours.

Why does treating the cheek sometimes help more than filling the fold?

Because a deep fold is often a sign of lost cheek support rather than a problem in the crease itself. Adding volume higher in the midface can change how the fold looks without placing filler in it. In the FDA trial of Juvederm Voluma XC, where injecting the folds was not allowed, 57% of the patients' own fold ratings (236 of 414) improved by at least 1 point at 6 months.

That was a self-assessment by the people treated, not a blinded measurement, and the FDA summary does not report the blinded evaluators' fold scores, so treat it as a signal rather than proof. It does suggest a practical rule: ask your injector to look at your cheeks before deciding how much filler, if any, the fold itself needs. If your cheeks have held their volume, treating the fold directly may make more sense.

Ask for the cheek-first and fold-only options side by side, with the product, amount and expected timeline for each. Our cheek filler guide covers how much filler FDA trials used in the midface and how long it lasted, and the cheek filler page describes the treatment. Some people end up with a little of both, and that is a reasonable outcome when the reasons are clear.

How long will fillers last in nasolabial folds?

Hyaluronic acid fillers in the folds are temporary and often last up to about a year. The patient labeling for Juvederm Ultra Plus XC says most patients need 1 treatment and results last about 1 year. Poly-L-lactic acid can last longer: in the 2009 FDA trial of Sculptra Aesthetic, improvement held through 25 months.

Maintenance shapes the real timeline. In the Juvederm Ultra Plus study, 76% of participants came back for a repeat treatment, on average 9 months after their last injection, and among the 23 who returned more than a year later, 78% still had some improvement. The labeling also says touch-ups and repeat injections are usually needed to keep the correction. Our dermal fillers page compares the filler families Derm Clinic MD offers.

Sculptra works differently. In its FDA trial, people received an average of 3.2 sessions spaced about 3 weeks apart, and 105 of the 106 people in the extension phase received no further Sculptra through 25 months. The trade-off is patience: change builds gradually instead of appearing at the visit, which suits some people and frustrates others.

What are the risks of nasolabial fold filler?

Most side effects are mild to moderate and short-lived, but most people get some. In the Juvederm Ultra Plus fold trial, redness, tenderness, firmness and swelling each appeared in more than 8 of 10 treated folds, usually lasting 7 days or less. The serious risk is accidental injection into a blood vessel, which is rare but can cause skin damage, vision loss or stroke, sometimes permanently.

The fold is not a zero-risk zone. In a 2025 American Academy of Ophthalmology review of 198 cases of vision loss after filler, the nasolabial fold was listed as the injection site in 9 cases, about 4% of injection sites, while the nose, forehead and area between the brows were far more common. Emergency treatment usually did not reverse the vision loss. The FDA advises immediate care for unusual pain, vision changes, skin near the injection site that turns white, gray or blue, or any sign of a stroke.

Fillers that are not hyaluronic acid carry their own trade-offs. In the Sculptra Aesthetic trial, 17.2% of treated people developed nodules or papules, small bumps under the skin, compared with 12.8% in the comparison group, and nodules first appeared a median of 160 days after the first session. Most resolved on their own. Hyaluronic acid filler has one practical advantage here: hyaluronidase, an enzyme that breaks down hyaluronic acid, can be used to treat problems.

What else softens smile lines besides filler?

Skin treatments can improve the surface around a fold, but they do not fill a deep one. The American Academy of Dermatology says microneedling can address wrinkles, fine lines and sagging skin, with full results taking several months. The Juvederm labeling also lists chemical peels, laser skin surface treatments and facial creams among other options for lines and wrinkles.

Think of these as skin quality treatments rather than volume treatments. If your fold is mostly fine lines and crepey skin beside the mouth, a skin treatment may be the gentler first step. If it is a deep crease from lost cheek support, surface treatments can make the skin look healthier without changing the shadow much. The 2025 Dermatologic Surgery panel describes peels and fractional lasers as complements that improve texture alongside volume treatment.

Microneedling is not for everyone. The AAD says to avoid it if you heal slowly or poorly, have had a keloid scar, have a weakened immune system, are being treated for skin cancer in the area, or are receiving radiation. Derm Clinic MD offers microneedling, chemical peels and laser resurfacing, so skin quality and filler can be weighed at the same consultation.

Which treatment fits your nasolabial folds?

No single option suits everyone, so match the treatment to the cause. Fine lines with little volume loss may suit skin treatments. A moderate fold with full cheeks may suit hyaluronic acid filler in the fold. A deep fold with flatter cheeks usually calls for a look at midface volume first. Poly-L-lactic acid (Sculptra) suits people who prefer gradual change.

Whatever you choose, ask for the FDA-approved use of the specific product, the expected timeline and what maintenance looks like. If you have a wedding or photos coming up, leave at least a week or two for swelling and bruising to settle, since most side effects in the Juvederm Ultra Plus labeling lasted 7 days or less. The AAD recommends sunscreen with SPF 30 or higher on all skin not covered by clothing.

At Derm Clinic MD, every treatment starts with an in-person consultation, where you can look at your folds in good light and compare options with an injector. When you are ready, book a consultation at our Buckhead or Cumming office, and bring photos from a few years ago if you have them, since they show how your midface has changed.

• Fine lines and crepey skin: start with skin quality treatments
• Moderate fold, cheeks still full: hyaluronic acid filler in the fold
• Deep fold, flatter cheeks: assess the midface first, then the fold
• Prefer gradual change over a few sessions: ask about poly-L-lactic acid (Sculptra)
• Any plan: daily broad-spectrum sunscreen, SPF 30 or higher

This article is general education and is not medical advice. It does not replace an in-person consultation. Whether a treatment suits you, and what result is realistic, depends on your health history and an examination.

Derm Clinic MD · Last updated October 2026.