Filling the nasolabial fold and tear-away groove: a dangerous area requiring caution

The trend of "youthifying the middle layer of the face" is sweeping across society, driving up demand for filling the nasolabial fold and tear-away groove (cleft lip, the hollow under the eye). On social media platforms, numerous quick-filling packages are advertised, promising to make you look younger in just 15 minutes, with no pain or downtime. However, the medical community continuously warns that these areas are among the most dangerous for injections. Understanding blood vessel anatomy, the risk of embolism, and the role of a specialized doctor is essential before making a decision.

Why is the nasolabial fold and tear-away groove called "dangerous"?

In cosmetic injection medicine, the face is divided into areas based on their level of risk. The nasolabial fold and around the tear-away groove are typically categorized as high-risk due to thick blood vessel density and direct connections with the eye's feeding arteries and brain.

• Nasolabial fold: has superficial and deep nasolabial arteries, located in multiple layers, making it difficult to determine the injection depth accurately.
• Tear-away groove (cleft lip): closely linked to the angle artery and eye arteries, which connect to the central retinal artery.
• The skin and tissue in these areas are thin, with overlapping surgical layers. Small errors in depth can lead to significant consequences.

It is precisely due to this "thin and connected" characteristic that procedures here require more solid and meticulous knowledge of anatomy and technique than those on the cheek or chin.

What is embolism and why should we be concerned?

Embolism (vascular occlusion) occurs when filler material inadvertently enters a blood vessel or compresses an artery, blocking blood flow to tissue. This condition is described in many medical reports and is the reason these areas are always mentioned with special caution.

• Skin embolism: causes skin discoloration, pain, which can lead to necrosis if not treated promptly.
• Retinal artery embolism: rare but serious, can cause vision loss or blindness, sometimes irreversible.
• Nervous system complications: in extremely rare cases, filler material may flow back into the brain's blood vessels.

It is crucial to emphasize: while these complications are rare when performed according to standard procedures, their consequences can be severe. Therefore, medical literature categorizes them as "low probability but high severity risks," requiring serious prevention rather than complacency.

Reducing risk with technology and technique: understanding correctly

The market is promoting many solutions claimed to be "absolutely safe." A more balanced view: these techniques help reduce the risk, not eliminate it entirely. They depend on skill level.

• Cannula: less likely to penetrate blood vessels than sharp needles in many situations, but does not completely rule out risk and depends on operator technique.
• Doppler ultrasound on-site: used by some clinics to locate blood vessels before injection; useful but requires a trained doctor to interpret images.
• Hyaluronic acid filler (HA): advantage is hyaluronidase men that can handle embolism, allowing early intervention. This is why many doctors prefer HA for high-risk areas.

Beware of exaggerated advertisements promising "new generation fillers never cause complications" or "machines removing 100% risk." There is no scientific evidence to support such absolute claims. Technology is a tool, and the operator's skill is decisive.

Safe procedure for high-risk areas

A standard process typically includes the following steps:

• Direct consultation, review of medical history, current medications, previous filler injections.
• Evaluation of individual anatomy, as blood vessel positions can vary between individuals.
• Slow injection, small amounts, low pressure, aspiration checks (aspiration) depending on technique and continuous monitoring of reactions.
• Preparation of emergency treatment plans and rescue medication for embolism at the facility.
• Guidance on warning signs after injection: unusual pain, widespread skin redden/blueness, blurred vision, severe headache requiring immediate contact.

Notes on local conditions and personal safety

Each person has a unique blood vessel map, skin texture, and individual reactions. Those with bleeding disorders, anticoagulant use, unclear filler type (especially non-degradable types like silicone), or facial infections need thorough evaluation and may sometimes be deferred. The results of cosmetic procedures and risk levels vary by individual, not transferable from another person's procedure. This is why direct consultation with a specialized doctor at the facility, equipped with adequate emergency equipment, is more important than any advertisement.

Dr. Vo Thanh Sang's Perspective

"The nasolabial fold and tear-away groove are always areas I approach with the highest caution. Filling here can help achieve a harmonious and youthful appearance, but I never promise a fixed result or claim 'absolute safety' to anyone. What I commit to is thorough examination, honest explanation of both benefits and limitations, and only proceeding when the risk assessment is acceptable for that individual. If any place advertises 'no risk eye injections,' it's a signal to pause and consider carefully."

If you are interested in filling the nasolabial fold and tear-away groove, prioritize a direct consultation for personalized advice based on your own condition. You can contact the hotline 079 7479 222 to schedule an appointment with a specialized doctor.

This article is for informational reference only and does not replace direct medical consultations and diagnoses.