Nasolabial fold filler disaster. What can I do?

Question

Hi, i'm a 46 year old woman, and about 3 years ago, i had fillers done, in my cheeks(looked great) but i regret that i had it done in my nasolabial folds, it looks very unnatural, the mounthline is puffy. Today my cheeks are back to normal but i still have that puffy line from the filler. went to see another doctor to have it dissolve, it looks better, not yet gone still 50% there, please help love from Belgium

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin. This is a great question. I recommend dissolving the remainder of the filler and waiting a period of time before re-injecting more filler. I highly recommend scheduling an in-person consultation in order to better assess your areas of concern and discuss an appropriate treatment plan to help achieve your aesthetic goals. Our office phone number is: (312) 944-0117. I hope this helps and best of luck!

Anna Chacon, MD, FAAD · Answer

First of all, I’m sorry you’ve been dealing with this for three years. I can hear how upsetting it has been, especially since you were happy with your cheek filler and only regret the treatment in the nasolabial folds. Please know that what you’re describing is not unusual, and the fact that the area improved after dissolving is actually a very encouraging sign.

The most important clue in your story is this:

Cheek filler has returned to normal
The fold area still looks puffy
Hyaluronidase (dissolving treatment) made it about 50% better

That pattern strongly suggests that residual hyaluronic acid filler is still present, rather than this being simply aging or permanent tissue damage.

Why Nasolabial Fold Filler Can Look Unnatural

The nasolabial fold is one of the trickiest places to inject. As we get into our 40s and beyond, the fold is often caused not just by a crease in the skin, but by volume loss in the cheeks and changes in the supporting tissues.

When filler is placed directly into the fold, especially if too much is used or it is placed superficially, it can create:

Puffiness beside the mouth
A thick or swollen-looking smile line
A “sausage-like” ridge
Heaviness that becomes more noticeable when talking or smiling

Many patients describe exactly what you did: “my mouth line looks puffy and unnatural.”

The Good News

Because you already had partial dissolution with visible improvement, I would not assume that you are left with a permanent “filler disaster.” In my experience, patients who improve 50% after hyaluronidase often improve further with additional conservative sessions.

One treatment is frequently not enough, especially when:

the filler was placed years ago,
it was densely packed,
or there is scar tissue or fibrosis mixed with the remaining filler.
What May Be Happening Now

At this stage, there are usually three possibilities:

1. Residual filler (most likely)

This is the most common explanation when the area softens after dissolving.

2. Filler-related fibrosis

Long-standing filler can sometimes stimulate scar-like tissue that feels firm or looks slightly raised even after much of the product is removed.

3. Edema (water retention around the filler)

Hyaluronic acid attracts water, and even a small amount of remaining product can continue to create disproportionate fullness.

What I Would Typically Consider

In a patient with your history, I would usually think in terms of gradual correction rather than aggressive dissolving:

Reassess the area after the first hyaluronidase session has fully settled (often several weeks).
If residual puffiness remains, consider small, targeted additional hyaluronidase treatments rather than a large single dose.
Evaluate whether any remaining fullness is soft and compressible (more suggestive of filler) or firm and tethered (more suggestive of fibrosis).
A Word of Reassurance

You are 46, and you are certainly not “too old” for this to improve. In fact, many women in their 40s and 50s seek help for persistent nasolabial filler fullness years after the original injection, and a significant number achieve a much more natural appearance once the residual product is carefully addressed.

The fact that:

your cheeks have returned to normal,
the fold improved with dissolving,
and only part of the puffiness remains

makes me optimistic that this is still a treatable filler-related issue rather than an irreversible outcome.

I would encourage patience with the process. After three years of living with an unnatural contour, it is completely understandable to want it gone immediately, but the safest and most natural-looking results usually come from slow, conservative dissolution with reassessment between sessions.

Sending you a big hug back from across the ocean, I know this has been emotionally exhausting, but your description suggests that you have already taken an important step in the right direction by having the filler partially dissolved, and the improvement you’ve seen so far is a very positive sign.

Camille Cash, MD · Answer

I'm sorry to hear that you were unhappy with your filler treatment.  It can take multiple treatments of hyaluronidase to fully dissolve filler.  I encourage you to return to your injector for an evaluation.

Nasolabial fold filler disaster. What can I do?

Answers (3)

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