What Are Nasolabial Folds? 4 Types and How to Treat Them Without Wasting Money

Nasolabial folds are what many people worry about most, since their depth is closely tied to how old you look. Many clients want them filled completely, until not a single line is left.

Nasolabial folds are expression lines everyone has. They cannot be removed completely, but they can be improved according to their type.

There are four types: hollow type (a hollow at the nasal base, filled with hyaluronic acid or Ellanse), muscular type (the nostril-side muscle happens to sit right on the fold, so it cannot be eliminated), sagging type (caused by drooping apple cheeks, needing a thread lift or HIFU lift), and fatty type (lines pressed in by fat; lose weight first, then lift). At Golden Apple Aesthetic Clinic, the combined approach I use most often is a thread lift plus hyaluronic acid to refine the nasolabial folds, treating sagging and hollowing at the same time.

Nasolabial folds cannot be erased by simply filling them without thought. Their causes are complex, involve the whole aging process, and are closely tied to how we smile. Over-filling easily makes a smile look stiff and unnatural, which defeats the purpose of improving them.

In this article I want to share what type your nasolabial folds are and what causes them, so you can choose the right aesthetic treatment for your case and not throw your money down the drain.

Contents

• Quick overview: 4 types, 4 treatments
• 1. What are nasolabial folds? What type are mine? (1) Are nasolabial folds the same as a hollow nasal base? (2) What is the difference between nasolabial folds and marionette lines?
• 2. What causes nasolabial folds? The 4 types (1) Hollow type: the easiest to treat, improved by filling (2) Sagging type: if you have marionette lines, you have this (3) Muscular type: cannot be eliminated (4) Fatty type: those with high body fat
• 3. Preventing and improving nasolabial folds (1) Care: 3 helpful lifestyle habits (2) Ways to reduce them: 4 aesthetic treatments. Treatment 1: Thread lift (sagging type). Who is suited to a nasolabial fold thread lift? Treatment 2: HIFU lift (prevention and maintenance). Treatment 3: Collagen stimulators (hollow type, long-lasting but not dissolvable). Treatment 4: Hyaluronic acid (hollow type, dissolvable). How are combined-type nasolabial folds treated?
• 4. How much do nasolabial fold treatments cost? Hollow type: cost comparison of fillers and surgery. Sagging type: cost of lifting
• 5. Nasolabial folds FAQ: Can nasolabial folds be removed completely? What is the difference between nasolabial folds and marionette lines? Can hyaluronic acid be injected into marionette lines? How do I tell which type I have? How long does a nasolabial fold thread lift last? Does a HIFU lift work on nasolabial folds? How can I keep nasolabial folds from deepening? How much does hyaluronic acid for nasolabial folds cost and how long does it last? How much does a nasolabial fold thread lift cost? Does botulinum toxin work for muscular-type folds? What if I still have nasolabial folds after lots of filler?
• Conclusion

Quick overview: 4 types, 4 treatments

1. What are nasolabial folds? What type are mine?

(1) Are nasolabial folds the same as a hollow nasal base?

Everyone has nasolabial folds. What aesthetic treatment can do is improve them, not eliminate them.

Otherwise you might end up like No-Face in Spirited Away, with no expression even when you smile. I have to say up front: even if you have had nasolabial fold implant surgery, a nasolabial fold thread lift, hyaluronic acid for nasolabial folds, and Ellanse for nasolabial folds, you may still find you have nasolabial folds. They are lines you are born with; aesthetic treatment only makes them look less deep.

The two main reasons nasolabial folds deepen: collagen loss + aging and sagging of the apple cheeks.

Collagen loss creates what is called a "hollow nasal base", the triangular nasolabial area in the picture below. Because collagen loss leaves a groove there, filling can improve the height difference and lighten the nasolabial fold.

If your nasolabial fold is one long line that, besides the triangular hollow, almost reaches the corner of your mouth, the main cause is usually sagging apple cheeks. Filling alone cannot solve this, and instead easily leads to side effects such as hyaluronic acid migration and a "monkey-face" look.

(2) What is the difference between nasolabial folds and marionette lines?

Nasolabial folds = hollow nasal base + the line beside the nose; marionette lines = the lines at the corners of the mouth. Nasolabial folds make you look 5-10 years older at most, but the appearance of marionette lines marks a critical watershed at age 45. Marionette lines make you look much older than nasolabial folds do and are harder to treat.

Let me expose my mom's photo: she has a bulge beside her mouth, which is the jowl, and the jowl forms a marionette line at the corner of her mouth. Once marionette lines form, they are very hard to get rid of.

Nasolabial folds are the two lines that appear when you smile. Marionette lines are the lines at the corners of the mouth formed when the jowls drop. Marionette lines cannot be lightened by filling. Many clients who had hyaluronic acid injected into marionette lines came to me afterward to have it dissolved, because the jowls got bigger the more was injected. Marionette lines are not caused by a hollow, so please do not inject hyaluronic acid there.

If marionette lines have appeared, you basically also have sagging-type nasolabial folds, and filling the folds alone will not give a significant result. The best approach is regular HIFU or thread lifts to slow tissue sagging, which can delay the age at which marionette lines appear.

Further reading: What are marionette lines? How can aesthetic treatment improve them?

2. What causes nasolabial folds? The 4 types

By cause, nasolabial folds fall into four types: hollow, muscular, sagging and fatty. As people age, most end up with several types at once.

(1) Hollow type: the easiest to treat, improved by filling

The hollow type is the hollow nasal base mentioned above. It is the easiest type to treat, and the hollow can be improved by filling with Ellanse or hyaluronic acid. Common causes of the hollowing include:

• Natural differences in bone structure, usually with a protruding mouth
• A hollow nasal base resulting from wearing braces
• Collagen loss with aging

The case below is a typical hollow nasal base. After filling with hyaluronic acid, the nasolabial folds improved.

(2) Sagging type: if you have marionette lines, you have this

Many of my clients worry about nasolabial folds not because of the line itself but because of the "sag". Facial sagging makes the folds look deeper and the face look tired. Many people desperately fill the folds flat, yet still feel they don't look any younger afterward. The biggest reason is that the underlying sagging was never solved.

The easiest sign of sagging-type nasolabial folds is whether you have marionette lines. If marionette lines have already appeared, you definitely also have sagging-type nasolabial folds.

To improve sagging-type folds, the best way is to reposition the sagging apple cheeks, which means choosing a lifting treatment such as HIFU or a thread lift.

In the picture below, Ying is an entrepreneur who often meets clients and wants to keep a youthful energy. Her biggest concerns were nasolabial folds and marionette lines. After a thread lift, both were lightened, and even her clients asked why she seemed several years younger lately.

(3) Muscular type: cannot be eliminated

Simply put, muscular-type nasolabial folds mean the muscle beside your nostril happens to sit right on the fold. People with this type have folds that look deeper than their peers' from a young age.

Nearly half of people have muscular-type nasolabial folds. You don't mind much when young, but as collagen is lost with age, hollow + sagging + muscular types appear together as a three-in-one fold, and many people find it unacceptable because it makes them look much older.

Facial lifting and hyaluronic acid filling can improve the sagging and hollow types, but the muscular type cannot be eliminated. So please stop asking me why you still have nasolabial folds after so many treatments. They are the muscles you smile with and cannot be removed 100%.

My wife is a typical muscular type. When she smiles, the muscles on both sides of her nostrils bulge noticeably, right above the folds. Even when I push her apple cheeks upward she still has nasolabial folds, which shows hers are not the sagging type but the natural muscular type.

Another tip for telling them apart: look at the direction of the fold. In people with muscular-type folds, the lines look like parentheses and curve inward toward the corners of the mouth as they age ( ). Ordinary folds open outward like the character 八. Muscular-type folds are also usually shorter, reaching only to beside the nose.

(4) Fatty type: those with high body fat

Kim Jong-un is a typical case of fatty-type + sagging-type nasolabial folds. Folds accompanied by fat usually become very tricky, and lowering body fat is still the best answer. When I weighed 120 kg I also had fatty-type folds, and they disappeared after I lost weight.

This is usually seen in people with higher body fat, where fat accumulates above and below the folds and its weight presses downward over time. In Kim's photo, the thick mass on both sides of the folds is fat, and it is usually accompanied by very obvious jowls.

The most effective way to improve fatty-type nasolabial folds is weight loss. Even with a thread lift it is hard to effectively reduce fatty-type folds, because the fat is too heavy for the threads to lift. A better approach is to lose a lot of weight first; this will be accompanied by loose, sagging skin that forms sagging-type folds, which can then be improved with a nasolabial fold thread lift. After a thread lift, fatty-type folds can also be combined with fat-dissolving injections to locally remove excess fat around the folds, for a better result.

So how much can each type be improved? This is the expectation that should be aligned first in a consultation. Below are reference ranges based on my clinical experience. You can see that the ceiling of minimally invasive treatment is about 50%; for a greater degree of improvement, you need to consider surgery.

The above are commonly seen clinical ranges for reference and are not a guarantee of results; actual results vary with severity, age and tissue condition.

3. Preventing and improving nasolabial folds

Everyone will eventually have nasolabial folds and this is unavoidable, but exercise, sun protection and diet control can keep them from deepening so quickly. Many people ask whether facial massage or beauty devices can lighten nasolabial folds. Honestly, the lifting from those beauty devices on the market is not as good as having a HIFU treatment once a year, and facial massage or trying not to smile often are not practical methods.

(1) Nasolabial fold care: 3 helpful lifestyle habits

• Build an exercise habit: No amount of HIFU compares to the collagen your body produces when you exercise. It is the most natural and effective way to firm up, and it can slow the speed of tissue sagging.
• Sun protection: Many people can still see the fold lines after a lift or filler. A big reason is that long-term sun exposure causes uneven color along the folds; even if the fold is filled flat, the discolored line remains. So choosing a good sunscreen and applying it consistently is important.
• Diet control: A large increase in fat makes the fat so heavy that the apple cheeks drop, producing fatty-type folds. Controlling body weight and fat through diet is therefore also a good way to prevent them.

(2) Ways to reduce nasolabial folds: 4 aesthetic treatments

Ages 20-30: This is the golden age for maintenance. The earlier you start, the longer you can stay frozen at that age. At this stage, I suggest using HIFU first to keep the skin firm and elastic.

Ages 30-50: By now almost everyone starts to show some sagging-type folds. A nasolabial fold thread lift can improve facial sagging and help avoid sagging-type folds and marionette lines later.

Over 50: At this age HIFU is basically already very weak and even thread lifts are barely effective. Some people's folds are so deep that even thread lifts don't work well, and more advanced facelift surgery may need to be considered for a more noticeable result.

Treatment 1: Thread lift (sagging type)

A thread lift uses fishbone-barbed threads to pull upward, lifting the sagging apple cheeks and jowls so that the apple cheeks return to position. This lightens the nasolabial folds and creates a firm V-shaped face.

Golden Apple Aesthetic Clinic uses the absorbable Mint Lift threads. The threads do not break easily, and a nasolabial fold lift lasts one to one and a half years.

In the picture below, the nasolabial folds and marionette lines of my nurse were already faintly appearing. Fortunately we gave her a thread lift + 1cc of hyaluronic acid for the nasolabial folds early on, and afterward both the folds and the jowls became much lighter.

Who is suited to a nasolabial fold thread lift?

A thread lift only "sounds" scary. The actual procedure is like injecting hyaluronic acid with a blunt cannula, except the filler is replaced by lifting threads. By comparison, fillers carry a risk of vascular occlusion, while a thread lift directly pulls the existing tissue upward. The following situations are especially suitable:

• Rapid weight loss over a short time, causing loose skin
• Over age 30 and finding HIFU of limited effect
• Nasolabial folds appearing together with jowls and marionette lines
• Wanting to improve overall sagging of the mid and lower face without surgery

The Mint Lift and Meteroa used at Golden Apple are both absorbable threads. The effect is natural and lasts about 1.5-2 years. For the differences between threads, see What is a thread lift? 6 types of thread and their costs.

Treatment 2: HIFU lift (prevention and maintenance)

A HIFU lift has no significant treatment effect on nasolabial folds. If your sagging-type folds are severe, HIFU cannot effectively lighten them, but regular treatment over the long term can help keep the folds from getting deeper. For example, my wife has HIFU every year for maintenance, which keeps her jawline well defined and makes her face less prone to looseness and sagging.

Treatment 3: Collagen stimulators (hollow type, long-lasting but not dissolvable)

In the past, for very deep hollow-type folds, the more lasting options were usually nasolabial fold implants or fat grafting. With the rise of collagen stimulators, filling can now also achieve a very lasting result.

The 5 main collagen stimulators on the market are Ellanse, Sculptra, Vivabella, Radiesse and Aesthefill. After injection, they stimulate your own collagen to grow, which fills the hollow. The advantage is that they are very long-lasting; the disadvantages are that they cannot be dissolved if you don't like them, and the amount of growth is not always as expected.

My friend is a typical hollow type. The folds below his nose line are not deep and are mainly concentrated in the hollow beside the nostril. He had Aesthefill on one side and Sculptra on the other, and at the three-month follow-up both sides had grown quite well and the hollow was clearly lighter. The amount of growth may differ between the two sides: everyone has a dominant side, and one side's muscles may be more developed. If there is slight asymmetry after three months, it can be fine-tuned by adding a little hyaluronic acid. To learn about the pros and cons of different collagen stimulators, see: How to choose a collagen stimulator? 6 compared.

Treatment 4: Hyaluronic acid (hollow type, dissolvable)

For hollow-nasal-base-type folds, I recommend Korean honeycomb hyaluronic acid or Juvederm Voluma. Both have good compatibility with tissue and a low allergy rate, and are very well suited to filling nasolabial folds.

For the pros and cons of hyaluronic acid for nasolabial folds, see this article: Does hyaluronic acid for nasolabial folds work well?

Of course, if hyaluronic acid for the folds can be combined with a thread lift, the result is still better than a single treatment. The picture below shows a typical sagging + hollow type. After a thread lift + 1cc of hyaluronic acid for the folds, her colleagues noticed she seemed 5 years younger.

If after seeing the cases above you feel the improvement is not very big: sorry, I'm not that talented. I don't retouch photos to exaggerate results, and I don't edit them into a different person like many Xiaohongshu videos. This is simply the limit of minimally invasive treatment. If you want a better result, consider nasolabial fold implant surgery ("noble" surgery) or facelift surgery.

How are combined-type nasolabial folds treated?

Many people actually have a mix of "hollow + sagging + fat", which cannot be handled with a single treatment. The right order is:

1. Assess the main cause first: Is it a hollow in the skeletal structure, sagging apple cheeks, or fat that is too heavy? If the main cause is not identified correctly, everything after is wasted.
2. Then combine different methods: for example nasal base filling + nasolabial fold thread lift + fat-dissolving injections, each addressing one layer.
3. Avoid over-filling: Repeatedly stuffing filler into the same spot only brings migration, swelling and unnatural expressions.

If you have already tried many treatments and feel they didn't work, the problem is likely with the diagnosis and not the treatment itself — for example, filling again and again when it is actually the sagging type, or expecting complete removal of a muscular type.

4. How much do nasolabial fold treatments cost?

Taking Golden Apple Aesthetic Clinic as an example, the prices of nasolabial fold treatments by procedure are shown in the table below:

Hollow type: cost comparison of fillers and surgery

The table above shows our clinic's prices for each treatment. If you want a side-by-side comparison of all the materials (including surgery) you can choose for hollow-type nasolabial folds, see this table:

Sagging type: cost of lifting

This is why I keep saying regular maintenance is worthwhile — regular thread lifts and HIFU can push back the age at which you need a facelift. For the full price list, see Golden Apple clinic treatment prices.

5. Nasolabial folds FAQ

Can nasolabial folds be removed completely?

It is very difficult to remove them completely. Nasolabial folds are lines you are born with, and even surgery can hardly make them disappear entirely.

What is the difference between nasolabial folds and marionette lines?

Nasolabial folds are the hollow nasal base + the line beside the nose; marionette lines are the lines at the corners of the mouth. Nasolabial folds make you look 5-10 years older at most, but the appearance of marionette lines marks a critical watershed at age 45, making you look much older than nasolabial folds do and being harder to treat.

Can hyaluronic acid be injected into marionette lines?

Please don't. Marionette lines are not caused by a hollow and cannot be lightened by filling. Many clients who had hyaluronic acid injected into marionette lines came to me afterward to have it dissolved, because the jowls got bigger the more was injected.

How do I tell which type of nasolabial fold I have?

Push your apple cheeks upward. If you still have nasolabial folds, it is not the sagging type. If marionette lines have already appeared, you definitely also have sagging-type folds. If the muscles on both sides of your nostrils bulge on the folds when you smile, it is the natural muscular type.

How long does a nasolabial fold thread lift last?

A thread lift lasts about one to one and a half years.

Does a HIFU lift work on nasolabial folds?

A HIFU lift has no significant treatment effect on nasolabial folds. When sagging-type folds are severe, HIFU cannot lighten them, but regular treatment over the long term can help keep the folds from getting deeper, so it is a maintenance treatment.

How can I keep nasolabial folds from deepening?

Build an exercise habit, protect against the sun, and control your diet. The collagen produced during exercise is the most natural and effective way to firm up; long-term sun exposure causes uneven color along the folds, so keep applying sunscreen; avoiding noticeable weight gain helps prevent fatty-type folds.

How much does hyaluronic acid for nasolabial folds cost and how long does it last?

Hyaluronic acid for nasolabial folds is about 1-2cc, priced at NT$10,000-25,000, and lasts 1-1.5 years. Ellanse or Sculptra for nasolabial folds costs NT$20,000-32,000 and can last over 2 years.

How much does a nasolabial fold thread lift cost?

A thread lift costs about NT$40,000-60,000, depending on the thread type and number of threads; facelift surgery costs NT$300,000-400,000. So regular maintenance is recommended, as it can delay the age at which you need a facelift.

Does botulinum toxin work for muscular-type nasolabial folds?

Botulinum toxin for nasolabial folds is a treatment I don't recommend very much. Muscular-type folds are the natural lines of smiling, and the principle of botulinum toxin here is to make it hard for you to smile, so the folds lighten. But is that really better? I feel a natural smile still looks best, and I don't recommend injecting botulinum toxin into the nasolabial folds.

What if I still have nasolabial folds after lots of filler?

Many people actually have a mix of "hollow + sagging + fat" and cannot be handled by hyaluronic acid or any single treatment alone. The right approach is to assess the main cause first, then combine nasal base hyaluronic acid + nasolabial fold thread lift + fat-dissolving injections and other combined treatments, while avoiding migration caused by over-filling.

Conclusion

The cause of nasolabial folds differs for everyone. Understanding which type you are, or even whether you are a combined type, lets you choose the right method and avoid wasting money for no result.

If you have tried many nasolabial fold treatments and still feel they didn't work, you may have chosen the wrong treatment, or your natural muscle lines may simply be especially deep. My own advice is still not to fill nasolabial folds to the extreme; keeping some of your natural lines is how you keep your most authentic self.

Not sure which type of nasolabial folds you have? Consult Dr. Ou at Golden Apple now!

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Written and updated by Dr. Ou Chia-Hung (founder and director of Golden Apple Aesthetic Clinic) | Last updated: August 27, 2026. This article is health education information and public reference prices, and is not an individual diagnosis or treatment recommendation.

Not sure whether a thread lift or filler suits you? Add us on LINE and send a photo of your nasolabial folds, and Dr. Ou will make a preliminary judgment of which type you have: @goldiapple (remember to include the @)