Why Nasolabial Fold Treatments Look Unnatural

The Truth About Nasolabial Fold ‘Overfilling’

STOP erasing the line

Are you accidentally making your patients look older, puffier, or even mouse-like when treating nasolabial folds? If this resonates with you, it’s not your fault. Overtreatment in this area is actually one of the most common filler mistakes that aesthetic practitioners make, and it can damage your patient’s confidence, harm your professional reputation, and even leave your clinic struggling to stay full.

All practitioners understand the risk that poor aesthetic results can damage your patient’s confidence. They can harm your professional reputation and they can leave your clinic struggling to stay full. So we must learn to create more beautiful natural filler results for our patients. There’s one simple shift that can change everything and help you avoid these common filler mistakes.

Why Nasolabial Fold Treatments Look Unnatural

One of the most common filler mistakes practitioners make is overfilling the nasolabial fold because they’re too focused on erasing the line itself rather than looking at the face as a whole. Many experienced practitioners admit to making this same mistake early in their careers, focusing on erasing the line itself rather than considering the entire facial structure.

We are not taught to think in three dimensions. We lack a holistic framework that takes into account not just the proportions, but also the shape and contour and the finer details of all of the face’s surface. This educational gap creates the foundation for the problems we see with nasolabial fold filler treatments.

The problem when you treat the nasolabial fold in isolation is that it starts to distort the face. It can look puffy, distorted, sometimes even change the dynamics of a smile. Before you know it, your patient, instead of just looking fresher and more natural, starts to look a bit strange. They may not even notice it themselves, but there’s something uncanny when you focus too much on single areas of the face that starts to develop.

The Cascade of Filler Complications from Overtreatment

The problem with aiming to eradicate a nasolabial fold is that there are multiple subtle knock-on effects that get increasingly strange as you keep trying. One of the weird ones is it will change how the lip moves. When you smile, you’re no longer able to elevate your top lip. So the top of your teeth start to be hidden by a lip that no longer moves out the way.

You also start to over project the midface, and it starts to look a bit mousy. You get this midface that dominates, is bigger than the chin, makes the nose look slightly smaller and can make the nose look like it’s stuck onto the surface of the face rather than integrated into it.

These dynamic and aesthetic changes are very easily picked up as strange. Even if people don’t know what is wrong, they know there’s something not right. It’s this overtreatment of the area that changes both the dynamics of the mouth but also the surface of the face and removes important detail that our brains use to define different elements of the face.

We need to know the difference between chin and cheek. We need to know the difference between the lip and the cheek. A subtle change in the surface of the skin is part of that. If you delete it, it doesn’t look natural and creates unnatural filler results.

A Learning Experience: When Filler Goes Wrong

During training many years ago, one practitioner learned to treat the nasolabial fold by following all the way up the fold and then treating around the nose, all the way up around the groove of the nose. Looking at the end result, it was clear that something wasn’t right. They’d completely erased the line and it created essentially a very weird looking result where the nose looks stuck on the surface rather than integrated into the face.

This is how many injectors have been taught to erase folds, but this approach demonstrates exactly why isolated treatment fails and leads to common filler mistakes. As we increasingly remove any sign of a fold, it starts to look increasingly unnatural. This is one of the key elements of training that is never taught – that we actually need all these details.

We need to see the difference between cheek and lip demarcated by a subtle fold. It’s only when that fold becomes too distracting that we treat it. But removing it entirely is also not the goal and often leads to overfilled nasolabial folds.

The Solution: Avoiding Common Filler Mistakes

The solution is to think differently about the face. We need to assess the face as a whole, but we also need to know where we need indentations and projections. They are all part of the face. The shape of the human face is not well taught in aesthetics. Until you understand these components, it’s hard to understand when you’ve added too much and when you’ve added just right and when it needs treating in the first place.

We rely on our patients to guide treatment decisions, but this so often leads to isolated focal treatments rather than holistic full face solutions. There needs to be a big shift in mindset around one particular thing: no patient wants filler in their nasal labial fold.

What they want is to look fresh, beautiful, natural – much higher level goals than just treating the fold. When they ask you for nasolabial fold filler, it’s because they think that’s what they’re going to get to look fresher, more beautiful. They think it’s going to make them look better. They think it’s going to make them look younger or more attractive. That’s their real goal.

They actually want an expert to give them younger and more attractive, not just filler in the fold. It’s this shift that will allow you to talk differently to your patients and avoid the common filler mistakes that lead to unnatural results, but you first need to know the shape and detail of the face so that you can make sure you make the right aesthetic judgment along the way.

Understanding Natural Facial Architecture

The missing component of aesthetic education when it comes to nasal labial folds is knowing that it is actually a low point, a definitive point of the face, just like the apex of a cheek is the definitive point of the cheek. Without knowing what should be there and what shouldn’t be there, it becomes very hard to know when to stop and avoid filler complications.

What is needed is a full three-dimensional aesthetic framework for every part of the face. There’s an important way of understanding the shape and form of the human face that is missing from aesthetics training. This framework will allow you to view the face more holistically rather than just targeting one problem area.

It’ll also teach you when to start and when to stop. Not simply the lines that we want to erase. The goal after all isn’t to simply erase any shadow or fold. It’s to create natural filler results that look beautiful and attractive. And that’s different from simply filling lines.

The Three-Dimensional Approach to Natural Results

If you could understand the three dimensional relationships between facial structures broken down into a framework that would allow you to decide when to treat, when not to treat, when a structure is undertreated, overtreated or just right, wouldn’t that make it a lot easier to create full face treatment plans that actually make patients better looking and avoid common filler mistakes?

This approach helps you bridge the gap between knowing how to inject and understanding why we need to inject or not inject in all areas of the face. This will empower you to create stunning natural filler results, even with larger volumes of filler.

Case Study: Achieving Natural Filler Results

Let me walk you through the decision making process with a patient who presented wanting nasolabial fold treatment, showing how to approach her nasolabial fold while ensuring she got natural filler results rather than just filling one line.

The first thing is to be aware of the basic shape of a cheek. Every cheek in a female has three distinct defining points. These are the most projected elements of a cheek. You have the angle of the zygoma, the gonion, which is the most lateral projected point of the cheek, and then there ideally should be an anterior projection here just on the same line.

There’s also the low point of the midface, which is actually the base of the nasal labial fold. This is a natural inverted point that helps define the shape of a cheek and differentiate the cheek and the lip. We also have two other low points to be aware of in the midface: the lateral canthus and an inverted point underneath the cheek.

The overall shape of the cheek is then decided by a defining line that connects these points together. This is the first line that needs to be created or preserved that defines the outer bulge of the cheek terminating at the nasal labial fold at its innermost point.

Underneath that we have the inverse defining line of the cheek. This is what gives the cheek its differentiating shape to the jawline. We can see the difference between cheek and jawline. You can also start to see how there is some emptiness below this, but also above where the cheek meets the lid.

Treatment Approach for Natural Results

Because some of this fold happens due to lost volume above, we will replace volume along this line in a way that also takes into account the overall shape of the cheek connecting the planes underneath it to the inverse line. Once this is done, the nasal labial fold is easy to treat without creating overfilled nasolabial folds.

The area to focus on is the lower aspect. This area is the most important aesthetically to soften. Bearing in mind, you don’t want to lose the disconnection between cheek and lip, you just want to soften it. The base of the nose needs to be defended. This is a natural low point and although you may add a little bit of volume, you’re not trying to completely delete or over project this point.

The approach when treating a nasal labial fold, which has a combination of a crease alongside volume loss, is to use a sandwich like technique. You can inject the base of the fold with piriform fossa injections. The mid layer is treated with a cannula to support the tissue but not treat the crease. And then the most superficial aspect, you can treat gently with a soft filler so that you just take away those deeper elements of the crease.

The end result should preserve the natural boundary between the lip and the cheek if the patient has this shape, creating natural filler results rather than the unnatural appearance that comes from common filler mistakes.

The Transformation to Natural Results

When you learn to see the face in three dimensions, you’ll start to identify the gap between the patient’s current appearance and their full aesthetic potential. This mindset of systematically breaking down individual components to see if they’re over or undertreated, to understand whether they are optimal or need more or less projection, will help you avoid filler complications and achieve natural filler results.

When you learn to see the face in three dimensions, you’ll start to identify the gap between a patient’s current appearance and their full aesthetic potential. This is the central skill of an aesthetic practitioner. This mindset not only transforms your results, but also builds long-term trust with your patients by consistently delivering natural filler results.

Conclusion: Mastering Natural Filler Results

Understanding why nasolabial fold treatments look unnatural and learning to avoid common filler mistakes transforms your approach to facial aesthetics. By viewing the face holistically rather than focusing on isolated problems, understanding the three-dimensional relationships between facial structures, and respecting natural anatomical landmarks, you can prevent overfilled nasolabial folds and other filler complications.

The goal isn’t to erase all lines and shadows but to create natural filler results that enhance your patient’s inherent beauty. This approach requires understanding when to treat, when not to treat, and when structures are undertreated, overtreated, or just right.

This framework helps bridge the gap between knowing how to inject and understanding why we need to inject or not inject in all areas of the face, empowering you to create stunning natural filler results that build patient trust and practice success while avoiding the common filler mistakes that lead to unnatural outcomes.