Nasolabial Fold Treatment in Korea: Start With the Cause

I'm Dr. Jong Seon Kim, a director at Gangnam HERA in Seoul. I'm a board member of the Korean Society of Aesthetic Surgery and of the International Petit Medical Society. Of all the lines people ask me about, nasolabial folds — the lines from the sides of the nose to the corners of the mouth — come up most. In this video I asked my colleague Dr. Jong Hoon Lee, who co-authored the textbook LIFTINGOLOGY, to explain where they come from and how we treat them.

My short answer: nasolabial fold treatment works when it matches the cause. Sagging is lifted, a deep groove is filled, an over-full fat mound is reduced — and the honest goal is a 60–70% improvement, not a fold that disappears.

Have people always worried about nasolabial folds?

For a very long time. Dr. Lee looked into the history for this video. In ancient Egypt, with its dry desert winds, care focused on moisturizing the skin with honey, milk and oils. In China, the tradition of acupuncture produced facial massage methods aimed at rejuvenation and smoothing wrinkles — the roots of the facial massage many women in Korea still use today. The concern is old; what has changed is how precisely we can treat it.

What causes nasolabial folds?

The biggest single cause is aging. After that come habits:

• Sleeping position. Sleeping on your side or face-down keeps pressing the skin in the same place.
• Strong, repeated expressions. Smiling uses four or five muscles that lift the lip, and as they work the skin folds. A natural smile is fine — it makes you more likeable, even if the fold shows a little.
• Rapid weight loss. Losing a lot of weight in one or two months is a common reason for a fold that suddenly looks deeper.

Do massage and face exercises work?

They help a little. If your skin is sagging downward, gently flicking and pushing it upward with your fingers works against that downward pull. Dr. Lee also mentioned a facial-exercise approach from researchers at Northwestern University in the US: puffing air into the mouth — making a "monkey face" — trains the ring-shaped muscle around the lips, which may soften the fold. Face rollers used to smooth the area can help slightly too. None of these will reverse sagging or a deep groove, but they are not useless.

Can skincare help nasolabial folds?

Yes, modestly. Hyaluronic acid is a natural part of your skin's connective tissue, along with collagen and elastin, and creams rich in it help with hydration. Retinol, a form of vitamin A often found in eye creams, has an antioxidant role and supports collagen production, so it can help with fine wrinkles. Antioxidant products with vitamins C and E can also help. Skincare improves the surface; it does not move tissue that has dropped.

How does a clinic treat nasolabial folds?

By finding the anatomical cause and treating that. Dr. Lee divides the causes into four: ligaments, fat, sagging skin and bone — plus muscle. Bone and muscle are the ones we cannot really change.

Bone — the part we cannot change

Some people are born with the bone beside the nose sitting deeper. With age, the upper jaw also resorbs. The front of the cheekbone is not flat; seen from the side it slopes backward, so as bone is lost, the tissue attached to it slides down more. We cannot stop that process. Where the bone is very deep, the groove can be filled.

Sagging — lift it

When the tissue has dropped, mild cases can be lifted with thread lifting. Severe cases need surgical lifting of the face and neck, which is a separate surgical conversation.

Fat — sometimes reduce, not fill

This is the one people miss. When the fat beside the fold is very full, it is like a high mountain next to a deep valley: the fold looks deep because the mound beside it is high. Here the answer is to lower the mountain. Filling the valley only makes the whole area heavier.

What do real cases look like?

The video shows four, and each was treated differently.

• A patient in their 60s with about 70% of the problem from sagging. Sagging had pulled down both the nasolabial fold and the marionette line. Thread lifting dealt with much of it, and filler then treated the points that were still hollow after lifting.
• An older patient with deep bone and very poor elasticity. Threads would not have been enough, so this case went to surgical lifting, with filler added afterwards.
• A patient with too much fat beside the fold and over the front cheek. Seen at 45 degrees, the problem was volume. Neither filling nor lifting alone would solve it, so the fat volume was reduced first — lowering the mountain.
• A patient treated with filler alone. There was little sagging. Dr. Lee noted that adding a collagen booster such as Juvelook could have improved the fine lines further.

The last two cases are the ones I want patients to notice: filler is excellent for a groove, and the wrong tool for a fat mound. If you are mostly interested in the filler side, which Korean filler suits nasolabial folds goes deeper, and you can read a real patient's nasolabial fold filler review.

What does treatment look like at HERA?

1. Diagnose the cause — bone depth, sagging, fat volume and skin quality, from the front and at 45 degrees.
2. Combine where needed — lift first if sagging dominates, reduce if the fat mound is the problem, then fill what is still hollow.
3. Use the least filler that works, in the right layer, so the face stays natural.
4. Itemized written estimate before treatment, and an English interpreter throughout.

Filler takes around 10–15 minutes with numbing cream or local anesthesia. Mild swelling, redness or bruising usually settles within 2–3 days, so most people continue their trip the same day. Domestic HA fillers generally last around 6–12 months and imported ones around 12–18 months. For lifting, see the thread lift patient guide.

The honest limits

Approaching nasolabial folds with the goal of erasing them 100% is risky. Dr. Lee and I both say this to patients: aim for a 60–70% improvement. Chasing a perfectly flat fold usually means overfilling, and the face loses its natural look. Bone loss and muscle action cannot be undone, and habits like side-sleeping will keep working on the fold. Massage and good skincare are still worth doing alongside treatment.

Nasolabial folds often come with marionette lines — our video on marionette lines uses the same fill, reduce and lift logic. You can see real HERA results in our before-and-after gallery.