About: The nasolabial folds, also known as smile lines or laugh lines are the folds that run from the corners of your nose down to the corners of your mouth and often become deeper and more evident as we smile. Marionette lines are essentially the downward continuation of these folds that run vertically down the chin making us look older, droopier, and emphasizing the jowls. Dermal filler injections can be administered to fill in these creases for facial rejuvenation and restoration of medial facial fullness.

Safety: Hyaluronic acid based dermal fillers are FDA approved to treat moderate to severe nasolabial folds after several successful clinical trials proving the procedure to be safe and effective with limited downtime, risks, or side effects.

Convenience: Nasolabial fold fillers are conveniently quick and take approximately 20 – 30 minutes to complete. With minimal to no downtime and/or side effects, this treatment is ideal for New Yorkers with a busy schedule as it allows to return to work and normal activities immediately after your appointment.

Cost: The average cost of smile line filler ranges $800 – $1200 per 1 syringe.

Efficacy: Soft tissue filler is the most popular minimally invasive cosmetic procedure to correct the appearance of nasolabial folds and has been proven effective in several clinical trials.


Smile lines are those long curved folds that appear at the corners of your nostrils (the ala nasi) and extend down in a convex shape to the edge of your mouth. As an area of skin that receives a lot of activity from talking, frowning, and smiling, it’s only natural that lines begin to form in this spot. This frequent use of the lip levator muscles, along with the way muscle fibers attach to the skin, creates these folds. 

Everybody has some indications of smile lines, especially as we get older and our skin loses plumpness and elasticity from decreased collagen. However, despite being so common, pronounced smile lines are often a source of frustration and one of the most obvious signs of mature skin. They can also lead to the prominence of the specific anatomical space located between the nose and cheek, what is referred to as Ristow’s space, the spot just inferior the nostrils.

As collagen levels go down, the appearance of skin deteriorates from lessened interaction between the dermal extracellular matrix and fibroblasts, along with reduced connective tissue components. Lots of sun exposure, as well as other age-accelerating factors like heavy smoking, drinking, or stress, can contribute to laugh lines forming. Despite their common appearance, very few people like their faces being littered with wrinkles; even young people are subject to the stress of smile lines and unwanted indents in this area.

More and more frequently, we are seeing minimally and non-invasive cosmetic procedures pop up in social media and in the presence of celebrities; we tend to associate these with celebs like the Kardashians, but almost every prominent figure in New York or Hollywood has been subject to cosmetic procedures at one time or another.

It’s no wonder that fillers for nasolabial folds are one of the most popular aesthetic treatments. In fact, it is one of the most frequently carried out non-surgical cosmetic procedures across the globe. People are more likely to turn to fillers than surgery to correct the fine lines on their face. 

before and after smile line injection with Juvederm filler
39 year old female 2 weeks after getting 2ml of Juvederm filler for nasolabial smile lines
before and after smile lines injections with Juvederm Ultra dermal filler
42 year old male 2 weeks post smile line injections with 2ml of Juvederm Ultra filler


The formation of smile lines is a multifactorial process and physicians must thoroughly understand all anatomical intricacies to effectively reverse the damage secondary to collagen loss, gravity and fat depletion.

The very basic way to think about nasolabial fold formation is to imagine a piece of paper being folded over the same line multiple times until the paper loses its integrity and that folding line looks deep and washed out. Essentially, over time both the levator muscles (zygomaticus major and minor plus levator labi superioris) and overlying skin contract in a predetermined pattern over the same vector, and the deep skin folds form over those lines of contraction as the collagen is so rapidly recycled and is no longer able to fill those lines.

Frequently, the formation of laugh lines is exacerbated by excess overhanging skin resulting from volume loss in the cheeks and specifically in the middle and lateral malar regions. As the fat pads in those areas deflate the skin descends inferiorly into the nasolabial territory. Hence, it is not uncommon to observe both the classical parenthesis lines from overactive muscles and aggravation in the appearance of nasolabial folds caused by skin laxity. 

When both causative factors are present they must be treated via different pathways. Correction of nasolabial folds secondary to collagen loss over the contraction lines is done by injecting any of the approved dermal fillers directly into those wrinkles through the subdermal plane. Malar fat pad deflation with corresponding shift of skin inferiorly towards the maxilla calls for cheek filler augmentation. Cheek filler injections will result in the lifting of the sagging skin and minimizing the severity of the nasolabial folds. 

Dr. Schwarzburg is a thorough, thoughtful and experienced injector that will take into account all of the above-mentioned variables when creating a treatment plan for his patients in New York. Failure to do that will lead to aesthetically displeasing outcomes. 


If you suffer from deep wrinkles along the lateral corners of your mouth, but do not want to waste money on useless cosmetic products or take the risk of possible fruitless surgery, dermal fillers may be a great option for you. Nasolabial folds always appear when people smile –– however, when you still see them whilst carrying a neutral expression, it might feel bothersome or unflattering. Beginning in your early 20s, you may already start to see these signs of aging, which is why fillers are something both young and older adults can take advantage of.

Facial fillers are very safe procedures; however, there are some restrictions and contraindications that may make you ineligible to have this procedure. 


If you have a lot of allergies, particularly against medications or any of the ingredients present in hyaluronic acid filler (lidocaine, or gram-positive bacterial proteins), you should avoid getting any kinds of fillers. Those with chronic inflammatory skin conditions or active skin infections are also not well-suited to this procedure. Minors, as well as women who are pregnant or breastfeeding, are not eligible for a laugh line procedure. Finally, those with bleeding disorders or a history of herpes should also not be getting facial fillers as this may lead to relapse.


One of the best aspects of filler injections is that there is not much required of the patient – both in terms of prep and aftercare. There are a few ways that you can ensure a smoother process and decreased side effects. Before your smile line filler session, avoid alcohol for 1-2 days, and NSAIDs like aspirin and ibuprofen as they can contribute to excessive bruising. If you take blood thinners, vitamins, or fish oil tablets, cease taking these for 3 to 5 days before your session. These measures can help prevent excess bruising.


Before your filler session, you will have a consultation with Dr. Schwarzburg in his private Manhattan office where he will assess the state of your facial wrinkles and folds, and during which you can express your concerns as well as goals. If you are unsure about the effects the treatment may have, Dr. Schwarzburg can answer your questions and also give you a realistic idea of what to expect. This is also the time to see if you are an eligible candidate with a suitable health history and no conditions that may affect the outcome of your filler.

On the day of your session – which may or may not be the same day as your consultation – we will take a few pictures of your face to keep on record, and to help you see your amazing before and after smile line results. The area will be sanitized with isopropyl alcohol. You will also receive a topical lidocaine and tetracaine numbing cream for your comfort.

When it comes to dermal filler injection techniques, this typically depends on the area and type of filler used. Filler injections to combat nasolabial folds generally take place in the deep pyriform space – which is located right beside the nostril, or the alar crease. Nasolabial folds are usually injected intradermally or subdermally with hyaluronic acid containing fillers, and into the supraperiosteal layer, which is deep enough to prevent the development of lumps.  Most clinicians use a retrograde multiple puncture approach, also called the fanning technique. Additionally, Dr. Schwarzburg employs a very thin, hollow needle for minimal discomfort and bruising.

After your treatment, the area will once again be cleaned and you will be given an ice pack to relieve any pain or swelling. You are free to continue your day right after.

before and after Juvederm filler for laugh lines
40 year old female after getting 2ml of Juvederm filler to fix laugh lines
results after nasolabial laugh line injections with Restylane
37 year old male status post nasolabial laugh line injection with 2ml of Restylane hyaluronic acid filler


Patients love the easy-breezy nature of dermal filler procedures, precisely because you can often have them done in the span of time it takes to grab groceries or have a lunch break. The consultation takes around 5 to 10 minutes;  the facial injections that follow should only take around 30 minutes. In general, you can expect to have a session last no longer than 45 minutes.

The most common side effects with nasolabial filler are swelling, bruising, and lumpiness following the procedure, which are reported in about half of patients – the most common of these is lumpiness and tenderness, associated with 43% and 41% of patients, respectively. It should be noted that these side effects are generally temporary (generally resolving within 3 to 7 days), mild and reversible.

In some cases, bumps and nodules can form as a result of fillers. Certain side effects such as these can be relieved through the dissolution of filler through hyaluronidase, at least in the case of HA-based fillers.

Other adverse complications related to smile line filler may include redness, pruritus, discoloration of the skin, pain, nodules, and, in rare instances, an infection which occurs in 1% of patients. Tyndall effect is a well-established complication affecting patients with thinner than average skin or very superficial filler placement. A typical presentation is a bluish tinge or discoloration that is visible through the skin and even makeup, and is present at all times. This problem is easily reversed with a small injection of Hylenex. Filler displacement is a well-recognized side effect too and depends on multiple factors. If the compound is placed in the wrong tissue plane it won’t be securely attached and can simply move around. Sometimes the forces exerted on the filler through facial expression play a role too – too much tension and pressure because of the strong facial muscles and the filler can be “pulled up” or “pulled down” depending on the dominant force.

More severe complications, like skin necrosis or stroke, are usually a result of vascular occlusion of the facial artery which runs frequently right below the course of injection.

All of the above-mentioned complications can be completely avoided or mitigated by seeing a board-certified, extremely knowledgeable, and well-trained doctor like Dr. Schwarzburg who has performed thousands of nasolabial fold filler injections at his private NYC clinic. 


There is little to no downtime you need to worry about after having injectable fillers. You may want to wait a day before going out or taking pictures, as there can be slight redness around the cheeks, nose, and mouth for a few hours at most. Some bruising and swelling may occur, which can be soothed using a warm compress or the ice pack that Dr. Schwarzburg will give you after your treatment.

To prevent the unsightly migration of filler or extra bruising, it’s best to forego exercise and alcohol for 48 hours after your session. You can, however, apply makeup half an hour after your smile line treatment. After two days, you are free to continue your life as normal.


There is no universal price for a session of facial filler for smile lines, but usually 1 syringe of dermal filler can cost between $700 and $1200. The prices can also fluctuate based on the location of the clinic you attend, as clinics in New York and Los Angeles tend to charge higher versus more suburban areas that are less expensive. The price also depends on how many syringes of filler are needed to smooth out your skin and fill in your nasolabial folds – some clinics offer discounts when multiple fillers are purchased in bulk or if they have promotions throughout the year. 

Importantly, the experience and training of your doctor play the most critical role, as saving a few hundred dollars when it comes to your face makes little sense. With Dr. Schwarzburg at his New York clinic, you can rest assured that you’d be getting the best smile line filler experience possible, and his qualifications may be more expensive than a nurse or other less experienced injector.


Soft tissue fillers are the most frequently performed non-surgical aesthetic treatments on a global scale. There is a wide range of dermal fillers that can be used to improve your smile lines, all of which are formulated with unique properties, varying levels of G-prime (viscosity and elasticity), and molecular weights. The best type of filler to use in this delicate yet mobile region of the face is a softer composition that allows natural facial movement and expression, which would be a low G-prime filler.

Fillers for facial rejuvenation usually consist of hyaluronic acid (HA), calcium hydroxyapatite (CaHA), collagen, or Poly-L-lactic acid (PLLA). Different fillers can help achieve different results and must be chosen carefully given the desired outcome and treatment area.

Juvederm Vollure is one of the softest fillers in the Juvederm line and is ideal for the nasolabial folds. Vollure utilizes Vycross cross-linking technology and consists of both high and low molecular weight hyaluronic acids leaving you with long-lasting, natural looking, and beautiful results. Other medium fillers with similar consistencies and density levels are a part of the Restylane family and RHA fillers. Juvederm and Restylane fillers are both hyaluronic acid based, though other fillers may also be calcium hydroxylapatite, Poly-L-lactic acid (PLLA), or Polymethylmethacrylate (PMMA) based. Hyaluronic acid based dermal fillers are preferred by most to treat smile and marionette lines and include Juvederm, Restylane, Belotero, Revanesse, and RHA, amongst others. 

Dense fillers, such as Radiesse, a calcium hydroxylapatite filler also known as “liquid bone”, are not ideal for nasolabial folds and should be used with caution and only if necessary in their diluted form.

The best way to find out which filler is right for you is to consult with Dr. Schwarzburg at his office in Manhattan to select the perfect filler to meet your individual medical and aesthetic needs.

results after smoothing deep smile lines with Juvederm dermal filler
23 year old female 1 week after getting 2ml of Juvederm filler to smooth out the smile lines
before and after Restylane filler injection to reduce the appearance of deep nasolabial smile folds
35 year old female post 1ml Restylane filler injection to reduce the appearance of deep nasolabial smile folds


Radiesse was one of the earliest fillers to get FDA approval and was specifically approved for treating deep nasolabial folds. However, with time its popularity waned and right now its use for smile lines correction is limited. Dr. Schwarzburg explains that Radiesse possesses unique properties that make it a tool of the last choice currently for laugh lines. Radiesse is composed of calcium hydroxylapatite crystals, a very dense mineral material resembling bone structure. It is very immunogenic and leads to intense collagenosis in human tissues. This extreme collagen production creates a very dense extracellular matrix which sometimes can look artificial or even restrict movement of the tissues producing an unnatural-looking and heavy smile, etc. Depending on how Radiesse is injected it can also create visible linear lumps that have poor cosmetic appearance and can be unnerving to the patients. Dr. Schwarzburg, a doctor practicing in NYC, recommends using any of the hyaluronic acid fillers because of their superior biomechanical properties that allow achieving a naturally appealing look.  


When getting a consultation for your smile line filler, you may hear Juvederm Vollure mentioned as a possible option for your personalized treatment. Juvederm Vollure is known for its increased longevity, touting an efficacy that lasts up to 18 months. This relatively new technology was approved for the use of facial rejuvenation by the FDA in 2017, and has since become extremely popular for its durability and smoothing of facial wrinkles both in the world and in New York City.

What makes this longevity possible? It has to do with Vycross technology, which combines high and low HA cross-linking – this allows the hyaluronic acid to remain bonded as a cohesive gel while also postponing its biological breakdown over time. 


There are plenty of treatment options available for treating smile lines; some are simple, such as topical agents and creams. Other treatments are a bit more invasive, but still minimally so; these include laser rejuvenation and chemical peels. Some patients wish to see more dramatic improvements in their skin and seek additional procedures to not only eliminate their smile lines, but restore the overall appearance of their face.

One way to restore smoother-looking skin is through a process called microneedling, or Secret RF microneedling. Treatments like this, as well as laser procedures like Fraxel Dual and Carbon laser, focus on resurfacing the skin, working against pigmentation and texture for a more even finish.

If you have pronounced wrinkles around your mouth, it’s likely that you are also dealing with thin skin or volume loss in other areas of the face. These issues can be addressed with other dermal fillers applied to certain areas, such as the cheeks, under eyes, jawline, or lips. Facial contouring can lead to a more flattering and energized look. Wrinkles and fine lines can further be targeted using Botox and Dysport; these treatments use botulinum toxin to relax the facial muscles that contribute to wrinkles through hyperactivity and contractions. With these muscles relaxed, creases are less likely to form in the first place.

Finally, loose skin or a droopy face can be corrected using the approach of a non-surgical facelift. PDO threads are inserted in a minimally invasive nature to draw the face upwards, working against downward sloping lines and creating firmer-looking skin as the threads themselves dissolve over time, leaving thick traces of collagen behind.


Every patient is different, so there is no single answer to this question. Typically, those seeking to eliminate their nasolabial folds require only one or two syringes of dermal filler; the severity of your facial lines, along with how much of a change you wish to see, will impact this amount. Nasolabial folds are made up of dense fibrous tissue, muscle bundles that initiate in the fold fascia, as well as muscle fibers that extend from the levator muscles of one’s upper lip. Some people have muscles that are thicker, or more pronounced, than others. These muscles provide support for the buccal fat pad superior to the fold; along with more active muscles, an excess of fat in this area can also cause one person to have a more apparent NLF than somebody else. People with more modest amounts of fat and muscle prominence may only need half a syringe, while others may require one syringe; more can be added to also address marionette lines inferior to the mouth. Dr. Schwarzburg can help you figure out how much filler is required for the most favorable outcome. You can always return for additional treatments or to maintain the results.


A lot of people are curious about getting filler to treat their facial wrinkles, but are hesitant about looking artificial or dealing with post-treatment puffiness. When it comes to nasolabial folds, it’s best to take a cautious and modest approach to prevent this. Dr. Schwarzburg prefers to start minimally when treating smile lines, sometimes with only half a syringe; it’s always possible to return for a touch-up, which is much easier than trying to dissolve filler afterward or looking overdone.

When performed correctly, smile line filler is not obvious and can instead look very balanced and natural. When you smile, several facial muscles are activated; the zygomaticus major and the zygomaticus minor are the groups of muscles responsible for pulling the mouth upward. The levator labii superioris and the levator anguli oris elevate the upper lip and tilt the angle of the mouth up; finally, the risorius is what pulls your mouth out horizontally. These muscles are not impacted by filler – meaning they will still contract, allowing you to have a smile that is beautiful and natural. You will mainly notice the difference when your mouth is relaxed and nasolabial folds are minimized. It takes an experienced professional and a solid discussion to make sure you get the best-looking results.


If you are worried about the procedure being painful, you should be happy to know that most patients find filler injections for nasolabial folds fairly tolerable. While the nasolabial compartment of the face is somewhat sensitive, any pain that is associated with the procedure is typically transient and mild. Right before your procedure, a strong lidocaine-containing topical numbing cream will be applied to help minimize discomfort, and the tiny needle used means you will most likely only experience a pinching sensation during the injection. Additionally, most fillers are infused with lidocaine to minimize pain.


The results after nasolabial fold injections are immediate as the skin gets smooth and the deep folds are filled out from within. However, the final outcome will take a couple of days to become apparent, as it takes some time for the initial swelling and erythema to go down. One of the markers of success is the degree of dermal and subdermal thickness as a result of collagen production. Dermal and subcutaneous thickness has been shown to increase from 1.5 cm to 2 cm in just two weeks after a facial filler procedure. 

Within a week or two of your procedure, you should schedule a follow-up appointment in which Dr. Schwarzburg can assess how your smile line filler has settled at his NYC dermatology clinic, and you can discuss maintenance or touch-ups if desired.


Before your filler treatment, you may be dealing with deep indentations along the inner part of your cheeks, or thin crepey skin both superior and inferior to your mouth. These lines are visible even when your face is relaxed, and can even appear as prominent folds.

After your treatment, the prominence of these lines will be greatly reduced. Getting fillers to correct smile lines leads to more youthful-looking skin that appears firm as well as flexible. It’s a well-known phenomenon that younger people tend to have greater skin elasticity – which we often refer to as skin that “bounces back” and maintains its integrity. This desirable quality can be replicated through facial fillers that smooth out nasolabial lines, decreasing the visibility of unsightly wrinkles and folds. You’ll have your beautiful smile, as well as glowing skin.


Most fillers are sustainable for around 1 year after treatment. Certain fillers, such as Juvederm Vollure, are formulated to last for up to 18 months. However, as everybody metabolizes filler differently, some may see their results starting to wane after about 9 months. Many patients who are happy with their results come in at this time, or even earlier, for a touch-up appointment to increase the longevity of their smile line filler outcome. Because smile lines are located in an area of the face that moves a lot –– through conversation, smiling, frowning, even grinding teeth at night –– fillers may not have the longevity as those injected in less active areas of the body. 


Marionette lines and smile lines are often used interchangeably, but they aren’t the exact same thing. Nasolabial folds run superior to the corners of the mouth, whereas marionette lines are inferior to the lips; they are essentially wrinkles that extend past the corners of the mouth –– like the lines you might see on an old-fashioned marionette doll. These can also be corrected through the injection of filler; the longevity of filler for marionette lines is similar to that of filler for nasolabial folds, especially since both are located in heavily mobile areas of the face. That means hyaluronic acid fillers for marionette lines tend to be effective for around 9 to 12 months.

before and after results demonstrating smoothing of the laugh lines with Juvederm Ultra dermal filler
31 year old female 2 weeks after undergoing treatment for nasolabial laugh lines smoothing with 1ml syringe of Juvederm Ultra hyaluronic acid filler
before and after results following Juvederm Ultra injections for smile lines
31 year old female 2 weeks after undergoing nasolabial smile line injections with 1ml syringe of Juvederm Ultra filler


Insurance companies do not typically cover cosmetic procedures unless in special cases, such as sex reassignment surgeries. In the case of facial fillers, it is unlikely your procedure will be covered by insurance.


Injectable fillers can do a wonderful job of reducing the appearance of nasolabial folds! Surgical treatments, such as the excision of nasolabial folds, have often proven ineffective against smile lines. Generally, surgery to correct nasolabial folds is considered excessive and risky, not to mention impractical given the necessary downtime. Some may opt for a surgical facelift, but even this only slightly decrease the depth of these folds.

Fillers, on the other hand, have been shown to significantly increase dermal thickness, particularly after hyaluronic acid injections. The cross-linking technology present in HA fillers also leads to increased longevity of this method. When fillers are injected into the NLF, it is into the dense inner layer, which exists beneath the malar fat pad on the superficial outer layer.

Hyaluronic acid is naturally found in the body; however, HA levels decrease as we age, which can make wrinkles and sagging skin more evident. Hyaluronic acid filler works on multiple levels: first, it replaces lost tissue volume, plumping up the skin. Second, HA is hydrophilic, meaning it attracts water and moisture to keep skin hydrated. Hyaluronic acid filler may encourage the proliferation of fibroblasts – cells that keep connective tissue intact – and promote collagen production.


Multiple clinical trials have convincingly demonstrated that correcting mild to moderate to severe nasolabial folds and smile lines with Juvederm fillers is extremely efficacious with a patient satisfaction rate approaching 95%. But if you don’t believe these dry statistics consider looking at multiple online review platforms such as RealSelf where patients rave about this procedure and how it helped them regain their confidence and made them look younger. With millions of patients getting this procedure done every year you can’t go wrong and should schedule your own rejuvenating treatment without delay! Also, don’t forget that if done preventatively when you only have minor laugh lines you can halt the development of this nuisance once and for all. 


Dermal fillers for laugh lines are considered safe. This particular area of dermal filler injection had to successfully undergo several clinical studies to prove both its safety and efficacy for FDA approval in 2006. Injecting dermal filler to replace lost nasolabial fat and to fill in deep wrinkles along the labiomandibular folds is safe as long as the procedure is performed by a skilled and experienced physician.

The mid face is extremely complex and requires a deep understanding of facial anatomy and specialization in minimally invasive cosmetic procedures and injectables to be injected properly. Different parts of the nasolabial fold itself call for different injection sites. For example, the inferior two-thirds of the fold require injection into the deep dermis or superficial subcutaneous plane; at the alar base, intradermal or periosteal plane injections are better. The periapical areas call for a deep depot injection technique. The injector must also take care not to puncture along the alar grooves, nasal sidewall, or alar rim; otherwise, they risk damage to the branches of the facial artery. Knowledge of the anatomy of subcutaneous tissue and muscles is also vital to avoid the facial artery. Dr. Schwarzburg is a board certified cosmetic physician practicing in New York with over a decade of experience in minimally invasive cosmetic medicine.


Smile line fillers have a lot of benefits; firstly, it is minimally invasive meaning that it requires no surgical intervention. As such there is no downtime associated with the treatment and risks and side effects are minimal to none. Dermal fillers offer instant results, making it convenient especially for those who have been waiting long enough to get rid of those parentheses around their mouths.

The downsides to nasolabial or nlf fillers are that the results are not permanent and require touch ups within 9 – 12 months post-injection to be maintained. There are some common side effects; due to the high vascularity in the NLF region, minor hematoma (bruising) resulting from blood leakage in the skin that can occur when small blood vessels are punctured. Edema (swelling) and puffiness due to excess fluid, as well as inflammation can often happen after the treatment. These side effects generally subside within several days after your initial appointment.


Most of us would like to see the parenthesis lines that follow the inner corners of our cheeks reduced. Whether you refer to them as laugh lines, nasolabial folds, or smile lines, they tend to deepen and become more obvious as we get older. These wrinkles, along with other signs of volume loss or aging in the face, can be propped up using injectable dermal fillers. This minimally invasive method is as safe as it is effective in creating enhanced, younger-looking skin. With a small chance of side effects and little downtime, Dr. Schwarzburg is qualified to help you get rid of persistent nasolabial folds.


Dr. Schwarzburg at Skinly Aesthetics is your number one choice for getting nasolabial folds corrected using filler. He specializes in a long list of non-invasive and minimally invasive procedures, boasting many years of experience and expertise in this field. For your ultimate smile, it’s best to see a board-certified physician who knows the ins and outs of such a procedure. Dr. Schwarzburg takes great care to ensure your procedure goes smoothly and without adverse effects, getting you the best rewards for minimal risk. To book your consultation and filler session, simply contact Skinly Aesthetics at, or call or text us at (212) 774-4264.