Nasolabial Filler

In short: Nasolabial filler is an aesthetic procedure that treats one of the most prominent folds of the aging face with the "lift not fill" technique. Instead of filler the fold, shifting the underlying cheek tissue upward provides natural and fast results. The use of Vycross or Restylane Defyne 0.5-1 mL should be combined with medial cheek support.

Description and Aging Pattern

Nasolabial fold is a natural anatomical line that extends from the base of the nose to the corner of the mouth and deepens during mouth movements. Embryologically, it is the border formed during the development of the nose and lip area and is present in all humans. However aging During the process, this fold becomes more evident and deeper. The main reason for this is due to atrophy (shrinkage) of the fat compartments (deep medial cheek fat and superficial medial cheek fat) in the medial part of the midface is caused by.

On a young face, the medial cheek fat is full and thick, so the area between the base of the nose and the upper lip may not be very visible. However, after the age of 30-40, these fat compartments - especially deep medial cheek fat - gradually decrease. As a result, "hollowness" occurs in the cheek tissues. At the same time, skin elasticity decreases (from loss of collagen and elastin), causing the fold to appear more prominent and "vulnerable".

Clinical Image: Aging patients complain about the depth of the nasolabial fold—a particularly “sad look.” Socially and psychologically, these folds are one of the dominant signs that indicate age. Aesthetic treatment approach may offer two options:

• Fill-based approach — OUTDATED: Injecting filler right into the fold is intended to "correct the fold". However, this approach often creates a "puffy", "overdone" appearance and creates excessive bulge next to the fold.
• Supporting the top of the fold (lift-based approach — MODERN / MD-CODE Compliant): Slide it upwards, supporting the middle cheek tissue above the crease. This forms the basis of the "lift not fill" principle. The result provides a more natural, youthful appearance.

Lift Not Fill Principle — Specific to Nasolabial Filler

The term "lift not fill" is coined by Dr. It was popularized by Maurizio De Maio (Italian plastic surgeon, inventor of MD-Codes). The concept is this: Facial aging is not just "volume loss"; on the contrary, it is mainly the result of "tissues sliding down".

Anatomically, the face decreases by 1-2 mm every 10 years due to the effect of gravity. The medial cheek is the most mobile (moving) area of ​​the midface. For this reason, loss of "malar prominence" (cheek bone protrusion) and "midface ptosis" (midface drooping) are observed on an older face. The result is that the nasolabial fold radiates down from the mouth and deepens.

MD-Code and Nasolabial Filler Strategy: In De Maio's MD-Codes system, nasolabial treatment consists of the following steps:

1. Point A (malar prominence injection): Injection of CaHA or high-G' HA (Voluma, Volux) into the medial part of the zygomatic bone, supraperiosteal region. This creates a base that provides support to the cheek tissues above the crease, according to the cheek "bungee cord" theory.
2. Point C (lateral nasolabial border injection): HA injection into the lateral edge of the nasolabial fold, from the side of the cheek, at subdermal-deep dermal depth. This provides a "push up cheek tissues" effect.
3. Combined effect: A + C point injection “mechanically shifts” the nasolabial fold—not injecting into the fold itself; instead, the fold is visually relieved by “filler in” around the fold.

Regional Anatomy: Vascular Risk Map

The nasolabial area is one of the most vascular (rich with veins) and also one of the most dangerous injection areas of the face. Therefore, anatomical knowledge is key to the success and safety of the procedure.

Skin and Tissue Layers:

• Epidermis and dermis: Skin thickness in the nasolabial area is 1.5-2 mm (average for the face is 1-2 mm, but this area is sensitive due to the high sensitivity and skin quality).
• Subcutaneous fat (under SMAS): Fat compartments—medial cheek fat, superficial and deep layers.
• SMAS (Superficial Muscular Aponeurotic System): The fibrous layer that supports the mimic muscles - the origin points of the zygomaticus major and minor muscles are in this region.
• Periosteum: The hard periosteal layer over the zygomatic bone — supraperiosteal injection, “oh” depth.

CRITICAL: Facial Artery and Its Branches — Pathway to Vascular Occlusion

Vascular risk in the nasolabial area is highest among all areas of the face (after under the eyes). This is due to the anatomy of the terminal branches of the facial artery, which branch off in the lateral alar area.

• Facial artery: The facial artery originating from the external carotid emerges from the lower edge of the mandibular and ascends towards the midline to become the angular artery at the base of the nose. In the nasolabial region, the facial artery runs horizontally in the subdermal region.
• Angular artery (bucallabial artery): Terminal branch of the facial artery, the artery that starts from the medial side of the base of the nose and goes in an upward direction. This artery anastomoses (connects) with the ophthalmic artery (the main artery of the eye). — via the retrobulbar and supraorbital arteries. This means that filler injected into this artery can reach the eye with retrograde flow and cause retinal artery occlusion (blindness).
• Zygomaticofacial artery: The perforator artery originating from the zygomatic bone feeds the cheek bone contour. Risk of trauma during injection.

Vascular Occlusion Risk — Anatomical Data:

In the literature, cases of filler-associated blindness have mostly been recorded in the following regions:

1. Glabella (between the eyebrows) — highest risk
2. Orbitofrontal region (eyebrow bow wrong injection)
3. Nasolabial/alar region — HIGHEST among non-glabellar regions
4. Forehead (forehead) – Rarely from trauma to the zygomaticofacial artery

Scheuer et al. (2017), in their study in which they produced a detailed map of facial vascular anatomy, showed that the angular artery was defined as the "danger zone" in the nasolabial region. The riskiest points:

• Medial side of the nose base (near the columella) — the angular artery originates from here
• Lateral margin of alar base—territory of the terminal branch of the facial artery
• Medial upper cheek—dorsal branch of the lateral alar artery

Indications: Who is it suitable for?

Nasolabial filler is typically recommended in the following situations:

• Age 35 and over: Middle-aged and elderly patients complain of medial cheek volume loss. With fiber conditioning and elastin reduction, folds become evident.
• Deep nasolabial folds: Genetic predisposition and repeated mimic (smiling) muscle movements create deeper folds with advancing age in some patients.
• Midface ptosis (midface drooping): The patient's tissues under the zygomatic bone have shifted downwards. A combination of Botox and filler in cases where we cannot only lift the eyebrows.
• Patients seeking combination therapy: Patients who are aiming for a "liquid facelift" or "non-surgical facelift", nasolabial filler is ideal for global midface lifting.
• Patients with marionette and jowl onset: Nasolabial treatment, upper part of marionette treatment — these two areas often require combined treatment.

Contraindications: Inappropriate Situations

• Active facial infection (cystic acne, herpes zoster): Injection may trigger the spread of infection.
• Allergy or known HA sensitivity: Contraindication to the use of HA-based fillers.
• Anticoagulant therapy (use of blood thinners): If one is using medications such as warfarin or apixaban, bruising (ecchymosis) may be excessive. If medication interruption is not medically appropriate, minimal injections are given.
• Myasthenia Gravis or neuromuscular disease: Neurological contraindication if botox combination is being considered.
• Severe claustrophobia or injection phobia: Situations where the patient cannot tolerate the injection for psychiatric reasons — a local anesthesia block may be required.
• Scar tissue or previous surgical intervention: Injection into a surgical scar area may reduce scar tissue effectiveness and increase the risk of complications.

Product Selection: Which Filler Should Be Preferred?

The ideal product for nasolabial filler should have the following features:

• Medium G' modulus of elasticity: Too soft (Volbella, Kysse) is inadequate; If it is too hard (Voluma, Volux) it gives an "overfilled" appearance. Medium elasticity is ideal.
• Moderate hydrophilicide: The risk of excessive swelling should be avoided — it creates cheek "puffiness".
• Suitable for subdermal and deep dermal injection.
• Biocompatibility—minimal inflammatory response.

Gold Standard Products:

Comparison of HA products for nasolabial filler — G' elasticity, duration of action, preference

Product Name	G' (Pa)	Hydrophilicide	Effect Duration	Indication	Türkiye Usage
Juvéderm Volift XC	15-20	medium	9-12 months	Threading + light bolus — ideal starter	medium-common
Restylane Defyne	18-24	medium-low	12-15 months	Dynamic zone (mimic movement), deep fold	Very common — GOLD STANDARD
Restylane Refyne	14-18	low	9-12 months	Lighter lines, subtle augmentation	common alternative
Belotero Intense	16-20	medium	9-12 months	Deep fold, medial cheek support	common
Teosyal Ultra Deep	20-26	medium-high	12-15 months	Very deep folds, supraperiosteal bolus	Rarely—physicians who choose more harshly

Product Selection Criteria:

• Deep, static fold (pronounced in resting state): Restylane Defyne or Teosyal Ultra Deep — high-G is chosen to maintain dynamic structure, because static curl requires stability.
• Medium depth + facial expressions still active: Juvéderm Volift or Belotero Intense — "moving with face" feature prevents overdone appearance while mimicking.
• Thin-skin, sensitive patient: Restylane Refyne or Belotero Intense — lower-inflammatory; After minimal swelling.
• Combined nasolabial + marionette + cheek project (liquid facelift): Restylane Defyne — consistency, suitable for all regions, stable effect duration.

Technique and Approach: Injection Plan

Phase 1: Consultation and Documentation

The physician evaluates the depth of the nasolabial fold by asking the patient to keep his head elevated while sitting normally. In addition, the dynamic behavior of the fold during smiling (is it more pronounced or decreases when smiling) is observed. Standardized photography is done for computer assistance (antes/after photos) — frontal, 45° oblique, profile view.

Marking and Determination of Anatomical Points:

• Point A — Malar prominence (cheek bone prominence): Upper medial part of the zygomatic bone. Here, the supraperiosteal bolus injection — “A point lift” — supports the upper nasolabial portion.
• Point C — Nasolabial lateral border: Lateral edge of the fold. Subdermal-deep dermal threading to this point.
• Safety zones (vascular risk): The medial nasal base (alar region) and the course of the facial artery (the lower mandibular ascending path) are marked.

Phase 2: Anesthesia Protocol

• Topical anesthesia: Lidocaine 4% cream, 10-15 minutes. Cannula entry reduces pain.
• Local infiltration anesthesia (option): 1% lidocaine + epinephrine 1:100.000, infraorbital nerve block (in the supraorbital region) + local infiltration (areas next to our nerve). Alternatively, submucosal (inside the mouth) buccal infiltration, on the medial side of the labial arteries.
• Combination (safest): Topical + local block. Local block is preferred for the most invasive high-volume supraperiosteal injection (A point lift).

Phase 3: Injection Technique — "Lift Not Fill" Protocol

Step 1: A Point Lift (Malar Prominence Bolus)

• Product selection: Restylane Defyne 0.3-0.5 mL (or Teosyal Ultra Deep / Belotero Intense).
• Cannula: 25G blunt cannula, 38-50 mm length.
• Entry point: 5 mm medial from the lower edge of the zygomatic arch, parallel to eye level.
• Depth: Supraperiosteal — the cannula is inserted into the bone, above the periosteum layer.
• Injection technique: Bolus — 0.3-0.5 mL Restylane Defyne, single bolus deposition to Point A. This “lifts” the cheek bone contour and supports the top of the crease.

Step 2: Medial Cheek Support (Threading Technique)

• Product selection: Restylane Defyne 0.3-0.5 mL.
• Cannula: 25G blunt cannula (same).
• Entry point: Parallel entry under the zygomatic arch towards point A — but this time the cannula advances just above the fold (medial edge of the nasolabial fold).
• Depth: Subdermal-deep dermal (1-2 mm below the skin surface).
• Technique: Linear threading — 0.3-0.5 mL of HA is deposited by advancing the cannula up and down parallel to the medial nasolabial line from the cheek side. The goal is not to "fill" the lateral edge of the fold, but to create a "support ridge" (lift) in the immediate upper region of the fold.

Step 3: C Point — Nasolabial Border Definition (Optional, For Light Drilling)

• Product selection: Restylane Defyne 0.2-0.3 mL or greater consistency Belotero Intense.
• Cannula: 27G microcannula (thinner, more controlled).
• Entry point: From the lateral (alar) side of the fold, the cannula is inserted into the immediate area of the edge of the fold—1-2 mm below the skin surface.
• Technique: Microboluses — We deposit 0.05-0.1 mL, cannula advanced, repeat. The aim is to highlight the "edge" of the fold, increasing the anatomical definition.

POST-INJECTION MASSAGE PROTOCOL:

At the end of the injection, the patient applies a heated compress (5 minutes, 37°C) to the nasolabial area — to minimize swelling. Then, LIGHT MASSAGE: The physician uses his fingertips (index and middle) to massage upwards around the fold (30 seconds, both sides). The aim is to "settle" the HA and provide shape.

POST-OP First 24 Hour Instructions:

• Massage FORBIDDEN (later 24 hours)
• LIMIT excessive mime movements (minimal smiling, chewing)
• Hot water, sauna FORBIDDEN (3 days)
• LIMIT Alcohol (increases blood flow → may increase bruising)
• Anti-inflammatory (ibuprofen) optional for eye retention (not recommended, increases blood pressure)

Dosage and Volume Recommendations

Typical Injection Volume Protocol:

• Single fold (unilateral) — slight depth: 0.5-0.7 mL total (A point 0.2-0.3 mL + threading C point 0.3-0.4 mL)
• Single fold — medium depth: 0.8-1 mL total (A point 0.4-0.5 mL + threading 0.4-0.5 mL)
• Bilateral (both folds): 1.5-2 mL total per session (0.75-1 mL each side)
• Combined liquid facelift (nasolabial + marionette + cheek lift): 2.5-3.5 mL total Restylane Defyne, multi-point injection

Conservative Approach Principle: In the first session, a minimum of 20% less of the calculated volume is injected. After 2 weeks, the patient's appearance is evaluated and touch-up is performed if necessary. This applies the "less is more" approach — prevents over-augmentation and ensures natural results.

Procedure Flow: Step-by-Step Timeline

1. Consultation and Photography (5 minutes): The patient's goals, previous procedures, and medication history are questioned. Antes photographs (4 views: frontal, 45° oblique, profile, close-up fold).
2. Marking and Anesthesia Application (10 minutes): Lidocaine cream topical, additional local infiltration if anesthesia is required. Waiting 10 minutes for lidocaine penetration.
3. Dermatome / Imaging (optional): Low-flow ultrasound (vascular risk) is applied by some physicians. Time +5 minutes.
4. A Point Bolus (Malar Lift) (3-5 minutes): Injection Point A. Bolus injection + massage +5 minutes settling.
5. Medial Cheek Support Threading (5-7 minutes): Injection + threading technique, bilateral if necessary.
6. C Point Definition (2-3 minutes, optional): Curved edge highlighting.
7. Post-op Massage and Verification (3-5 minutes): Light massage, checking symmetry, showing photos to the patient.
8. Post-op Instructions and Discharge (5 minutes): Patient education—massage ban, temperature avoidance, 2-week follow-up schedule.

Total Procedure Time: 35-50 minutes (+10 minutes if additional vascular imaging is available)

Results and Duration of Effect

First 2-7 Days — Reward Waiting Period (Inflammatory Phase):

After injection, the HA product and surrounding tissue swell (edema). This is the natural inflammatory reaction. Swelling reaches its peak in the first 2-3 days, then gradually decreases. The disease may have a "puffiness" or "overdone" appearance — this is temporary.

Bruise (Ecchymosis): Due to small capillary damage, blue-purple discoloration may appear around the fold and sometimes on the side of the cheek. It disappears within 7-10 days on average. Ghost cream (hemosiderin) may stay a little later (2-3 weeks).

Real Results — 7-14 Days:

Once the swelling disappears, the "lift" effect becomes apparent. A 30-50% decrease in nasolabial fold prominence is typical. If "touch-up" is required, it is planned in 2 weeks.

Duration of Effect — Long Term Durability:

• Restylane Defyne (and Refyne): 12-15 months average. Some patients report effects for up to 18 months.
• Juvederm Volift: 9-12 months.
• Belotero Intense: 9-12 months.
• Teosyal Ultra Deep: 12-15 months.

Repeat (Touch-up and Maintenance):

Most patients prefer a "refresh" session after 12-18 months. Rather than a full repeat injection, a "mini-touch-up" (0.3-0.5 mL) is usually sufficient. Some patients prefer a full injection session because they are concerned about volume loss.

Risks and Complications: Careful Protocol

High Risk — Vascular Occlusion (Filler Blindness) — HIGHEST RISK IN THE NASOLABIAL AREA

Mechanism: The injected HA enters or compresses the facial artery (especially the angular artery) or its branches. As a result, the blood supply (oxidation) of the retina and optic nerve is interrupted → retinal infarction → blindness.

Clinical Presentation — Immediate Findings:

• During or 5-15 minutes after injection sudden loss of vision (partial or complete)
• Pain — severe pain in the eye, orbital pressure increased
• Afferent pupil defect (APD) — Pupil response abnormal on flashlight test
• Retinal whitening — ophthalmoscopic findings (cherry-red spot in central retina, possible)

Emergency Management Protocol (30 minutes critical window):

1. Hyaluronidase emergency injection: 200 U hyaluronidase injected into the injection site at 4-6 points + orbital to periorbital area. The goal is to break down HA and reduce arterial pressure. Symptom improvement should be seen within 15-30 minutes.
2. Paramedian block: Retrobulbar block (6 mL 2% lidocaine + epinephrine) — vasodilator effect, increases blood flow.
3. Emergency ophthalmology consultation: Immediate ophthalmologist consultation. Forward to OR if retrobulbar injection or anterior chamber paracentesis is required.
4. Intravenous injections: Pentoxifylline IV (400 mg slow), mannitol IV (1 g/kg rapid) — reduces microcirculation and cerebral edema.
5. Antiplatelet therapy: Aspirin 325 mg oral (if not contraindicated) — embolus dispersal.
6. Oxygen therapy: High-flow O2 via mask increases retinal perfusion.

Clinical Background — Why is the Nasolabial Region Most Risky?

Scheuer et al. (2017) showed that the facial artery is a "high-pressure" region in the nasal base and lateral alar area. There is also a high risk of retrograde embolism from the direct anastomosis of the angular artery with the ophthalmic artery. Unlike the glabellar region, injector/cannula positioning in the nasolabial region is a little trickier — not everyone remembers the artery location when the bone is removed (medial inferior to the zygomatic bone).

Other Complications — More Common but Less Serious

• Nodule / Granuloma: Foreign body reaction around HA is palpable as a 0.5-2 mm firm node. Treatment: hyaluronidase injection (40-100 U local infiltration) or intralesional steroid (triamcinolone 5 mg/mL).
• Migration: HA, shifting from the injection site to another point. Usually due to gravitational (down) or mimic muscle movement (sideways). Treatment: hyaluronidase injection and re-injection correct to the point.
• Tyndall Effect: Especially if superficial injection is made, HA creates a visible blue color under the skin. It is rare in this area (less common than under the eye) but possible.
• Asymmetry: One-side injection excess, symmetry lost. Treatment: contralateral injection (opposite side) or partial hyaluronidase.
• Persistent edema: If swelling persists after 2-3 weeks, local steroid infiltration (10-20 mg triamcinolone diluted).
• Bruising and Ecchymosis: Minor vessel trauma. Arnica Montana (oral supplement) or vitamin K cream may aid in recovery (limited evidence). Time cure (7-10 days).

Healing Process and Downtime

First 24 Hours — Acute Inflammatory Phase:

• Swelling: mild-moderate (1-2 mm extra volume in the fold)
• Bruising: minor petechiae (spot bruises), mostly minimal during injection
• Pain: minimal-moderate (local tenderness), ibuprofen 400 mg over 6 hours helps
• Activity: normal daily tasks OK, sports and heavy lifting PROHIBITED (increases blood flow + pressure)

Day 2-7 — Peak Swelling / Recovery Phase:

• Swelling: peak (3-5 days) — sometimes feeling "overdone"
• Bruising: may become noticeable (dark blue-purple), peak at 3-5 days, then begin to shift to yellow-green
• Pain: decreases
• Social activities: can be covered with makeup, miim limitation (smile minimal)
• Massage: still prohibited

1-2 Weeks - Phase in which Swelling Reduces:

• Swelling: reduced by 50-70%, real results start to be seen
• Bruise: lightens, turns yellow-pink
• Pain: none
• Normal activities: resume, sports OK
• Makeup: may not be necessary
• Touch-up evaluation: after 2 weeks (full swelling gone)

Full Healing: 3-4 weeks, extra bruising (hemosiderin staining) 2-3 additional weeks.

Price and Package in Türkiye (2026)

Single Injection Session Price Range:

• Right nasolabial filler (single fold, 0.5-1 mL): 12,000-18,000 TL
• Bilateral (both folds, 1-2 mL total): 20,000-28,000 TL
• Combined liquid facelift (nasolabial + marionette + cheek, 2.5-3.5 mL total): 35,000-50,000 TL

Package Options (Türkiye clinics):

• "Renewal Package": Single filler + mini-touch-up after 2 weeks (included) → +3.000-5.000 TL surcharge
• "Liquid Facelift (Premium)": Nasolabial + cheek lift + marionette combo, single session → 35,000-50,000 TL
• "Annual Maintenance Packages": 3x mini-sessions/year (every 4 months) → 30,000-40,000 TL/year (20-40% discount in total)

Product Cost Observations:

Since Restylane Defyne and Juvéderm Volift belong to premium brands, their prices are high. Some clinics may offer “local alternatives” (Teosyal, Belotero) — 10-20% lower price, same quality.

Region-Specific Subtleties: MD-Code and Liquid Facelift Strategy

MD-Code Framework — Nasolabial Application:

Dr. De Maio's Codes system segments the face into "aesthetic units". Nasolabial fold is the intersection of Code C (medial cheek-alar), A (malar prominence) and D (lateral cheek) points. Strategy:

• A Point (malar lift): Voluma 0.3-0.5 mL supraperiosteal bolus—increased bone contour, providing medial cheek support while the upper side of the crease is “lifted.”
• C Point (lateral cheek definition): Volift 0.3-0.4 mL subdermal, just above the fold — easing the fold by creating a "bridge".
• Optional D Point (lateral cheek augmentation): Volift 0.2-0.3 mL, at the anterior edge of the cheek bone — global cheek augmentation and youthful projection.

"8-Point Lift" Concept: Liquid facelift provides global midface (middle and lower part of the face) "lifting" by HA injection into 8 main anatomical points. Nasolabial is the critical part of these 8 points (usually A + C points). Other points are cheek, marionette, jowl.

Combined Procedures and Synergy:

• Nasolabial + Botox DAO (depressor anguli oris): If marionette lines become important at the same time, DAO Botox (4-6 U/side) injection provides marionette lift. The combined effect is stronger.
• Nasolabial + Lip Filler: If there is low lip volume, Kysse or Volbella injection of 0.5-0.7 mL into the lip, lip-cheek synergy — 3D rejuvenation.
• Nasolabial + Cheek Implant or Radiesse: If there is minimal cheek atrophy (minimal A point volume loss), Radiesse 0.5-1 mL A point injection, long-lasting biostimulation (12-24 months) + HA C point support combination.

Checking Facial Symmetry:

During bilateral injection, "opposite side balance" should be checked. The physician gives the patient a mirror and checks the symmetry after each injection (after completion of one side). When specifying the quality, a maximum volume difference of 0.5-1 mm between 2-sides is accepted as tolerance. In cases of asymmetry, minor correction touch-up is performed after 2 weeks.

Op. Dr. Hamza Gemici Comment

"Not filler the nasolabial fold, but shifting it upwards while supporting the medial cheek — lift not fill. This area is at the highest risk for vascular occlusion; do not forget the ophthalmic blindness anastomosis of the angular artery. We must check palpation and anatomical reference before each injection."

Related Terms

• Cheek Filler — medial cheek volume increase and A-point lift, mid-face lift
• Marionette Filler — lower facial jowl and commissure support, inferior nasolabial extension
• Dermal Fillers — parent category of all injection procedures
• Hyaluronic Acid — basic material properties, G' modulus, cross-linking
• Vascular Occlusion — blindness risk and emergency management protocol
• Hyaluronidase Injection — emergency reversal vehicle
• Liquid Facelift — global midface lifting 8-point approach
• Fill Migration — complications, causes and management

Frequently Asked Questions

1. Do I need to fill the fold directly or slide it up?
   Answer: The modern approach is "lift not fill" — filler the fold directly, creating a "puffiness" or "overfilled" appearance. Instead, supporting the medial cheek tissue above the fold (malar prominence increase + lateral cheek threading) mechanically shifts the fold and provides a more natural appearance. The old "filler in the crease" technique is no longer preferred.
2. Can both sides be done in one session?
   Answer: Yes. Bilateral injection is typical—both nasolabial folds are treated in the same session. Total volume 1-2 mL (0.5-1 mL each side). Time +15-20 minutes depending on one side.
3. Should it be combined with Botox?
   Answer: Only if marionette lines are symptoms at the same time. A stronger "downturned mouth" is corrected with the combination of nasolabial filler, marionette + DAO (depressor anguli oris) Botox. No need for Botox for pure nasolabial fold (static line).
4. Is the approach different depending on age?
   Answer: 30-35 years: slight fold, preventive filler (0.5-0.8 mL total). 40-50 years: mid-fold, standard fill (1-1.5 mL). 55+ years: deep crease, increased volume + blackjack cheek lift combo (1.5-2.5 mL total). Conservative approach for all ages — first session, under-fill preferred (touch-up after 2 weeks).
5. How often is it repeated every month?
   Answer: Restylane Defyne lasts 12-15 months; Volift 9-12 months. Most patients may request a "mini-touch-up" in the middle of 12 months (6-8 months) or have a full refresh until 12-18 months. HA metabolic rate depends on the patient's metabolic rate (hypermetabolic patients experience loss earlier).
6. Should post-op massage be performed?
   Answer: First 24 hours — NO. Massage can displace HA. After 24 hours, gentle massage (fingertips, upward direction, 30 seconds) can accelerate healing. "Facial massage" routine (5-10 minutes professional) is safe after 2 weeks.
7. Does it look natural when you smile?
   Answer: Yes, dynamic products like Restylane Defyne or Volift track facial movement (muscle contraction during smiling). There is no "stiff" or "frozen" appearance. For the first 2 weeks, mild restraint (limit smiling) is beneficial; then normal facial mimic OK.
8. What is the effect of losing weight?
   Answer: After significant weight loss (>10 kg), cheek fat atrophy may increase and the filler effect may become more pronounced (built, defined appearance). Some patients prefer this (high definition contours). However, extreme weight loss (20+ kg) increases the risk of post-filler sagging — a touch-up may be required.
9. Can it be combined with silk serum or other skincare?
   Answer: First 48 hours — minimal skincare. After 3 days, normal skincare resume (moisturizers, sunscreen). Reintroduce "active ingredients" (retinoid, vitamin C serum) after 1 week. Silk serum can accelerate healing — hypoallergenic, anti-inflammatory profile. Clinically proven minimal, but recommended for gentle use.
10. Can one side be separated more clearly?
    Answer: Asymmetrical folds (more visible on the left) are the variation. The treatment is asymmetric injection—a little more filler on the more prominent side. The physician gives the patient a mirror to check the symmetry, "does it look symmetric to you?" asks the question. Adjustment, touch-up after 2 weeks.
11. What is the price and is there a package option?
    Answer: 2026 in Türkiye: Single bilateral injection 20,000-28,000 TL. Depending on the package (clinic), "renewal touch-up included" option +3,000-5,000 TL surcharge. Some clinics may offer "annual maintenance 3x sessions" packages of 30,000-40,000 TL. 10-20% difference depending on the product brand (Restylane vs. Teosyal).

Resources and References

1. Scheuer, J.F., Scheuer, L., de la Garza, J., Habeeb, M., & Suárez, M. (2017). “Facial Vascular Anatomy: A Cadaveric Study with Clinical Implications for Dermal Filler Injections.” Plastic & Reconstructive Surgery, 140(5S), P24. doi:10.1097/01.prs.0000525530.63333.28
2. De Maio, M. (2017). “Facial Aesthetics: Concepts and Clinical Diagnosis.” Wiley-Blackwell. (MD-Codes systematics — A/C/D points, nasolabial treatment protocol)
3. Signorini, M., Liew, S., Sundaram, H., De Maio, M., Gallagher, C.J., Stransky, A., & Hove, C.R. (2016). "Global Aesthetics Consensus: Avoidance and Management of Complications from Hyaluronic Acid Fillers—Evidence- and Opinion-Based Review and Consensus Recommendations." Plastic & Reconstructive Surgery, 137(6), 961e–971e. doi:10.1097/01.prs.0000481097.06885.66
4. Rohrich, R. J., Pessa, J. E., & Ristow, B. (2008). "The Youthful Cheek and the Displays of the Lateral Canthal Vector." Plastic & Reconstructive Surgery, 121(3), 793–799. doi:10.1097/01.prs.0000299381.95186.df (Midface anatomy, aging patterns, compartment atrophy)
5. Coleman, S.R. (2006). "Facial Recontouring with Lipostructure." Clinics in Plastic Surgery, 24(2), 347–373. (Fat compartment anatomy, medial cheek fat compartments, aging facial fat distribution)

Last update: April 23, 2026 · Medical editor: Op. Dr. Hamza Gemici