More filler for nasolabial folds is better? Why a doctor may advise against it
"I had filler in my nasolabial folds, but smiling looks awkward." "I had 1 cc injected. Why can't I see a difference?" "Would more help?"
These are the questions I hear most often in repeat consultations for nasolabial filler.
First, adding more solves the issue less often than people expect. Some faces actually look less natural as more is added.
I do not decide on filler by looking only at the nasolabial folds. I compare smiling and neutral expressions and first identify which volume loss has made the line deeper.
Why don't nasolabial folds always begin at the fold?
If asked, "Isn't it enough to fill the groove?", I answer directly. Some folds become less visible when filled, but others produce a heavier, less defined appearance as more is added. With age, the midface—the cheekbone and cheek region—loses volume, and tissue descends. That tissue gathers at the nasolabial area, making the crease appear deeper. If the cause lies above but only the resulting groove is filled, the wrinkle may soften while the mouth area becomes bulky and heavy-looking. This often explains why someone feels less natural after filler. If the problem does not start at the fold, filler should not necessarily start there either. This does not apply to every fold, of course. A shallow local depression may need only a small addition directly to the area. The important point is identifying which kind you have before treatment; that is the consultation's first role.
Why can the same 1 cc produce different results?
Even the same 1 cc can produce entirely different results depending on its position, depth, and direction. I call this a vector: something defined not only by magnitude but also by direction. One plan places a small amount deep above the periosteum to support tissue like a pillar; another spreads it thinly in the subcutaneous layer to fill a hollow. Even in the same area, changing the layer changes the filler’s role. Although the concern may be nasolabial folds, the starting point is often a cheek support point below the cheekbone. In practice, I frequently see 0.5–1 cc planned to support descended tissue upward look more natural than two or three times that volume placed only in the groove. Conversely, filler without consideration of vectors can make the face look wider or expression less natural as volume increases. What is needed is not more volume, but precise coordinates and direction. Think of a tent: when fabric sags, vector planning means finding and positioning its supporting poles, rather than adding more fabric over it. Correctly positioned poles can organize the entire surface with little force.
Fill everything at once, or in stages?
When asked, "Can't it all be done in one visit?", I explain that the face takes 2–4 weeks to show its settled appearance as swelling subsides. Adding volume based on the immediate post-treatment face can leave a result that exceeds the plan once swelling resolves. I therefore often choose to fill the necessary support points first, observe progress, and then decide the next step. This allows fine adjustments in 0.1 cc increments and reduces overcorrection risk. If existing filler already looks unnatural, there is an additional step to consider. Sometimes dissolving and clearing the old filler, then planning again from the beginning, is preferable to layering more on top. People also worry, "Will dissolving return my original face?" Hyaluronic acid filler can be addressed with a dissolving agent; the usual sequence is to let the skin settle afterward and then make a new plan. Which option is appropriate depends on the position and amount of remaining filler, so this too is decided during consultation after assessing the entire face.
Why consultation takes time
During filler consultations, I assess the structure of the whole face before focusing on one wrinkle. I examine not only the front but the profile and the direction in which expressions move while smiling and speaking. After identifying where volume has been lost and where tissue has descended, I plan only the amount needed at the points requiring support. In some cases, I may recommend a thread lift or collagen-stimulating injections rather than filler. I personally handle planning, treatment, and follow-up, and care takes place in an individual room. Filler is injected near anatomical structures such as blood vessels. Temporary bruising or swelling may occur, and rare complications requiring immediate intervention have also been reported. This is why I consider familiarity with layers and directions important, and explain in advance that results vary between individuals. After treatment, we schedule a follow-up to assess the face once swelling settles and determine whether another step is needed. Many people come after consultations at several clinics in Cheongdam. Wherever you choose, a useful criterion is whether you received an explanation of where filler will be placed and in which direction.
If you are considering nasolabial filler, I recommend asking "Where will you inject, and why?" rather than only "How many cc?" A clinic that answers that question can be a reasonable choice, even if it is not LUNN Clinic.
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