Optimizing Deep Nasolabial Fold Correction with Juvéderm Ultra Plus XC

Doris Dickson Dermal Fillers July 2, 2025

Deep nasolabial folds (NLFs) are among the most common concerns that drive patients to seek aesthetic treatment. More than just “smile lines,” these prominent folds can create an appearance of fatigue or premature aging. While many dermal fillers address superficial lines, correcting deep, structurally significant NLFs requires a product with specific lifting and supporting properties.

For clinicians, selecting the right tool is critical. Juvéderm Ultra Plus XC, a key product in the Allergan portfolio, stands out as a robust and reliable solution for this challenging indication. This guide explores why Ultra Plus XC is ideal for deep NLFs and outlines a protocol for achieving safe, effective, and natural-looking results.

The Challenge: Understanding the Anatomy of Deep Nasolabial Folds

Treating deep NLFs effectively requires more than filling a line. It demands an understanding of the multi-factorial aging process behind them:

Mid-Face Volume Loss: The primary contributor is often the deflation and descent of the malar fat pads in the cheeks. This loss of structural support causes the overlying tissue to sag, deepening the fold.
Ligamentous Support: The zygomatic and maxillary retaining ligaments can weaken over time, further contributing to tissue descent.
Bone Resorption: Age-related changes in the maxillary bone, particularly around the piriform aperture, reduce foundational support for the overlying soft tissues.
Dermal Changes: Loss of collagen and elastin in the dermis reduces skin quality and its ability to resist creasing.

A thin, low-viscosity filler cannot counteract these structural changes. Correcting deep NLFs requires a filler that provides foundational lift, acts as a scaffold, and restores lost volume—precisely the role of Juvéderm Ultra Plus XC.

Product Profile: Why Juvéderm Ultra Plus XC is an Ideal Tool

When you buy Juvéderm Ultra Plus for your clinic, you invest in a product with rheological properties engineered for deep tissue support. Its efficacy stems from Allergan’s Hylacross™ technology.

High Viscosity and Cohesivity: Ultra Plus XC is more highly cross-linked and viscous than Juvéderm Ultra. This creates a firmer, more robust filler that provides excellent lift and projection while resisting spreading.
Excellent Structural Support (High G’): The high G-prime (G’) of Ultra Plus XC allows it to resist deformation and effectively lift the NLF from below, rather than just filling the superficial crease.
Durability in a Dynamic Area: The nasolabial region is highly mobile. Hylacross™ technology ensures Ultra Plus XC withstands facial movements, with results lasting up to a year or more.
Patient Comfort: The inclusion of 0.3% lidocaine (“XC” designation) significantly improves comfort during injection.

Clinical Protocol: A Step-by-Step Approach to Treating NLFs

Achieving superior results requires a meticulous approach from assessment to injection.

Step 1: Patient Assessment and Consultation

Evaluate the patient at rest and during animation (smiling). Determine whether the fold results from mid-face volume loss, a deep dermal crease, or both. Manage expectations by explaining the goal is softening, not complete erasure, for a natural appearance. Review medical history and contraindications.

Step 2: Treatment Planning and Marking

For deep NLFs, a multi-point injection plan is often most effective:

Foundation First: Mark the piriform aperture. Treating this area first with a small bolus provides foundational support and lifts the superior aspect of the fold.
The Fold Itself: Mark the length of the nasolabial fold requiring correction.

Step 3: Injection Technique and Depth

Tool Selection: A 27G or 30G needle allows precise placement. A blunt-tip cannula (e.g., 25G or 27G) can minimize bruising and enhance safety.
Injection Plane: For the piriform aperture, use a deep supraperiosteal injection. For the fold itself, inject into the deep dermis or subcutaneous plane. Avoid superficial placement to prevent visible product or lumps.
Technique: Use linear threading (smooth product deposition upon withdrawal) or fanning/cross-hatching for broader volume loss adjacent to the fold.

Step 4: Volume and Post-Treatment Care

A conservative approach is best. Typically, 0.5mL to 1.0mL per side is used, depending on severity. Slightly under-correct and schedule a follow-up if needed. Gently mold the product post-injection for smooth integration. Advise patients to avoid strenuous exercise and excessive heat for 24-48 hours.

Safety and Sourcing: The Pillars of Your Practice

Patient safety is paramount. Be mindful of the facial artery and its branches in this region. Always aspirate before injecting to reduce intravascular risks.

Product integrity is equally critical. Counterfeit products pose significant risks. Sourcing from a trusted distributor like Health Supplies Plus ensures authenticity, sterility, and proper storage, protecting patients and your practice’s reputation.

Conclusion

Juvéderm® Ultra Plus XC is a powerful solution for deep nasolabial folds, offering the structural support and durability this area demands. By combining anatomical knowledge, precise injection techniques, and authentic product sourcing, clinicians can deliver natural-looking results that restore youthfulness and confidence.

Equip Your Practice with Juvéderm® Ultra Plus XC

Frequently Asked Questions about Juvéderm Ultra Plus XC

1. What is the primary difference between Juvéderm® Ultra XC and Ultra Plus XC?

Juvéderm® Ultra Plus XC has a higher concentration of cross-linked hyaluronic acid, making it thicker, more viscous, and firmer (higher G’) than Juvéderm® Ultra XC. Ultra Plus is ideal for deeper wrinkles requiring structural support, while Ultra suits moderate lines and subtle lip enhancement.

2. What is the recommended injection depth for NLFs with Ultra Plus XC?

For the main body of the fold, inject into the deep dermis or subcutaneous tissue. Superficial placement may cause visible ridges. For foundational support at the piriform aperture, a supraperiosteal injection is most effective.

3. Can Ultra Plus XC be used with a cannula?

Yes. A 25G or 27G blunt-tip cannula is excellent for linear threading along the nasolabial fold, potentially reducing bruising and intravascular risks compared to a needle.

4. How much product is typically required to treat bilateral nasolabial folds?

Typically, 0.5 mL to 1.0 mL per side, totaling one to two 1.0mL syringes. A conservative approach is advisable.

5. What is the expected longevity of Ultra Plus XC in the nasolabial folds?

Results can last up to one year or slightly more, depending on metabolism, lifestyle, and product amount.

6. Is Juvéderm® Ultra Plus XC reversible?

Yes. As a hyaluronic acid-based filler, it can be dissolved with hyaluronidase, a critical safety feature for complications or undesirable outcomes.

7. How does Hylacross™ technology benefit this specific product?

Hylacross™ creates a highly cross-linked, smooth gel, giving Ultra Plus XC its high viscosity and cohesivity for superior lift and durability in deep facial structures.

8. Are there other on-label or common off-label indications for Ultra Plus XC?

Yes. It is also used for pronounced lip augmentation, marionette lines, and other areas requiring significant volume correction.

9. What are the key signs of a counterfeit product to look out for?

Check for intact safety seals, professional packaging with accurate lot numbers, and consistent branding. The gel should be clear and particle-free. Always purchase from reputable suppliers.

10. What is the best way to manage post-injection swelling for this robust filler?

Advise patients to apply a cold compress intermittently for 24 hours, sleep with their head elevated, and avoid high-sodium foods and alcohol to minimize swelling.

Doris Dickson

About the Author: Doris Dickson is a specialist writer for Health Supplies Plus, focusing on the aesthetic medicine industry. She diligently researches cosmetic treatments and products to provide clear, concise information relevant to licensed medical professionals. Her work supports Health Supplies Plus’s commitment to being a reliable informational resource and trusted supplier for the aesthetic community.

Disclaimer: The content provided in this article is intended for informational purposes only and is directed towards licensed medical professionals. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment, nor does it constitute an endorsement of any specific product or technique. Practitioners must rely on their own professional judgment, clinical experience, and knowledge of patient needs, and should always consult the full product prescribing information and relevant clinical guidelines before use. Health Supplies Plus does not provide medical advice.