What is nasolabial dermal filler?
Nasolabial dermal filler is the procedure in which it is assessed whether a dermal filler product containing hyaluronic acid is to be delivered into the area of the nasolabial fold, which runs from the side of the nose towards the corner of the mouth.
The product used is a medical device (opens in a new tab), and in Türkiye medical devices are monitored through the Product Tracking System (ÜTS) (opens in a new tab).
One thing to know first:
In vascular terms, this is one of the areas of the face that requires the greatest care. The vessels that pass around the side of the nose are connected to the network of vessels supplying the eye. Vascular occlusion, which may be seen in dermal filler procedures, may in this area lead both to tissue loss in the skin and, although rarely, to loss of vision.
This possibility is explained in detail before the procedure, and it requires intervention within minutes to hours.
The limit of expectations: The nasolabial fold is an anatomical structure present in everyone; removing it completely is not the aim, and should not be. An excessive amount of product may lead to heaviness in the area and an unnatural appearance.
Dr. Suzan Alp, Specialist in Internal Medicine, performs the procedure at the practice (opens in a new tab).
Which factors determine whether the procedure is suitable?
The decision on suitability is made at the end of the consultation. The following factors are decisive in the assessment:
- The depth of the nasolabial fold
- Whether the nasolabial fold appears with movement, or whether it is also present when the face is at rest
- The state of the tissue support in the cheek area
- The thickness of the skin and the degree of laxity
- The existing symmetry between the two halves of the face
- Dermal filler previously applied to the area: its type and when it was given
- Whether there is a history of cold sores (herpes)
- Which medicines are being used, and whether there is a bleeding tendency
In which patients is the procedure not performed?
- In patients with a history of allergy to the product to be used or to its components
- In patients with a history of allergy to the dissolving enzyme (intervention would not be possible if it were needed)
- In pregnant and breastfeeding patients
- In patients under 18 years of age
Situations that require separate assessment
- Bleeding or clotting disorder, or use of blood-thinning or anticoagulant medicines
- Active infection or febrile illness (the procedure is postponed)
- Autoimmune disease in an active phase (the opinion of the relevant specialist physician is obtained)
- Treatment that suppresses the immune system (the opinion of the relevant specialist physician is obtained)
- Uncontrolled diabetes (healing may be affected)
- Smoking (tissue healing may be affected; discussed at the consultation)
Additional conditions specific to this area
The procedure is not performed if the following are present in the area to be treated:
- An active infection, a cold sore, an acne lesion or an open wound
In these situations, the procedure is planned subject to the physician’s assessment:
- Previous nasal surgery (the vascular structure of the area may have been altered; assessment by the relevant specialist is required)
- A non-absorbable type of dermal filler previously applied to the area (the opinion of the relevant specialist is sought)
- Frequent cold sores (the procedure may trigger one; precautions are planned together)
- A tendency to keloid or hypertrophic scarring (a raised scar that spreads beyond the original wound)
If dental treatment has recently been carried out or is planned, the procedure is postponed.
How is the procedure performed?
- Assessment. The depth of the fold, whether it becomes marked with movement, and the tissue support in the cheek area are assessed. Any history of nasal surgery, any history of cold sores, and previous dermal filler procedures and their type are asked about. Any history of allergy, bleeding tendency and current medication are recorded. Blood pressure and pulse are measured.
- Product check. The ÜTS registration, packaging integrity and expiry date of the product to be used are checked. The dissolving enzyme must be available where the procedure is carried out.
- Information and consent. The procedure, the fact that this area carries a high vascular risk, the possibility of vascular occlusion and of loss of vision, the limit of expectations and possible side effects are explained in detail; the form is signed. The symptoms for which help should be sought without delay after the procedure are given in writing.
- Preparation. There must be no make-up on the area. Antisepsis is ensured.
- Application. The product is delivered into the intended layer, in a measured amount.
- Observation and follow-up. The patient is kept under observation after the procedure; vision and the area are checked for signs of vascular occlusion. Vital signs and observations are recorded in the file. A follow-up appointment is arranged.
When is the effect seen, and how long does it last?
The appearance seen in the first few days is not the final result; the swelling is allowed to subside before the result is assessed.
The effect is temporary. The product used is absorbed over time; the duration varies from person to person, by area and by product, and cannot be stated in advance.
What should you do before and after the procedure?
Before the procedure, report:
- A list of all the medicines and supplements you use (in particular blood thinners, painkillers and herbal products)
- Your known allergies
- Your pregnancy and breastfeeding status
Come with no make-up on the area.
For this area, also state the following:
- Have you had nasal surgery?
- Do you have a tendency to develop cold sores?
- Have you had dermal filler in this area before? When, and of what type?
- Have you had dental treatment recently, or are you planning any?
After:
- Swelling and bruising are to be expected
- The area must not be massaged or rubbed
- You are advised to avoid exaggerated facial expressions for a period
- You are asked to avoid sleeping face down and putting pressure on the area for a period
- The period given for hot environments, saunas, sunbeds, swimming pools and intense exercise must be observed
- You are asked to keep the written list of warnings you are given
Recommendations and time periods specific to you are given in writing at the end of the procedure.
Risks and side effects
This area is among those that carry a high vascular risk.
Requiring urgent assessment
- Vascular occlusion. The signs: pain that is more severe than expected and increasing, blanching of the skin, a purple-red change in colour in a net-like or spotted pattern, coldness of the area, and crusting and sores at a later stage
- Tissue loss in the skin (necrosis); reported in the nasolabial area at the side of the nose and around it
- Loss of vision or a change in vision (rarely seen; the vessels of the nasolabial area are connected to the network of vessels supplying the eye)
- Infection and abscess at the site of the procedure
Other risks specific to this area
- Asymmetry
- Firmness, irregularity or a nodule that can be felt by hand
- A feeling of heaviness in the area and an unnatural appearance (as a result of an excessive amount of product)
- Displacement of the product over time
- Triggering of a cold sore
- The area becoming more marked when smiling
- The expected change not being seen (where skin laxity or cheek support is the prominent finding, the result is limited)
General risks that may occur with any minor procedure
- Swelling, bruising, pain and tenderness
- Temporary change in sensation
- Allergic reaction
- Swelling and redness appearing at a late stage
Results vary from person to person. No guarantee can be given as to a result or a duration.
When should you see a physician without delay?
If you experience these symptoms during treatment, contact your physician without delay:
- Increasing redness, increased warmth, swelling or discharge in the area
- A high fever
- Crusting or the formation of sores on the skin
- Widespread rash, itching
In the event of pain that is more severe than expected and steadily increasing, blanching of the skin (particularly at the side of the nose and around it), a purple-red change in colour in a net-like or spotted pattern, or coldness or paleness of the area, contact your physician at once; if you cannot reach them, go to the nearest emergency department. In the event of any change in vision, or rapidly increasing swelling of the lips and eyelids, go directly to the emergency department.
Frequently asked questions
What is the most serious risk of nasolabial dermal filler?
It is vascular occlusion. In vascular terms, this is one of the areas of the face that requires the greatest care; the vessels that pass around the side of the nose are connected to the network of vessels supplying the eye. It may lead to tissue loss in the skin and, although rarely, to loss of vision.
Will my nasolabial line go away completely?
The nasolabial fold is an anatomical structure present in everyone; removing it completely is not the aim, and should not be. An excessive amount of product may lead to heaviness in the area and an unnatural appearance.
Is this area assessed on its own?
No. The appearance in this area is mostly assessed together with the tissue support in the cheek area. Which area is to have the procedure, and to what extent, is decided at the consultation; Cheek Dermal Filler is described on a separate page.
I have had nasal surgery — can the procedure be carried out?
In those who have had nasal surgery, the vascular structure of the area may have been altered; the procedure is not performed without obtaining the opinion of the relevant specialist physician. State the type and date of your operation at the consultation.
I have a tendency to develop cold sores — will this be a problem?
The area is adjacent to the region around the mouth, and the procedure may trigger a cold sore. If there is an active cold sore in the area, the procedure is not carried out; in those who develop cold sores frequently, suitability and the precautions to be taken are assessed separately.
I smoke — will this have an effect?
In those who smoke, tissue healing may be affected. This is one of the matters discussed at the consultation, and it is taken into account when the procedure is planned.
How long does the effect of nasolabial dermal filler last?
The effect is temporary; the product used is absorbed over time. The duration varies from person to person, by area and by product, and cannot be stated in advance.
Is nasolabial dermal filler performed during pregnancy?
No. The procedure is not performed during pregnancy or while breastfeeding.
Sources
- Ministry of Health of the Republic of Türkiye, Turkish Medicines and Medical Devices Agency, Tıbbi Cihaz ve Ürün Takip Sistemi (ÜTS). https://www.titck.gov.tr/faaliyetalanlari/tibbicihaz (opens in a new tab)
- Ministry of Health of the Republic of Türkiye, Turkish Medicines and Medical Devices Agency, Tıbbi Cihaz Yönetmeliği, Official Gazette 2 June 2021 / 31499 (repeated). https://www.mevzuat.gov.tr/mevzuat?MevzuatNo=38657&MevzuatTur=7&MevzuatTertip=5 (opens in a new tab)
- Ministry of Health of the Republic of Türkiye, Ayakta Teşhis ve Tedavi Yapılan Özel Sağlık Kuruluşları Hakkında Yönetmelikte Değişiklik Yapılmasına Dair Yönetmelik, Official Gazette 7 January 2025 / 32775. https://www.resmigazete.gov.tr/eskiler/2025/01/20250107-3.htm (opens in a new tab)
