Nasolabial Folds: Causes and How to Get Rid of Them

Nasolabial folds — the lines running from the sides of the nose to the corners of the mouth — are one of the most commonly treated areas in facial aesthetics. Most people call them smile lines, laugh lines or laughter lines, and if you are wondering how to get rid of nasolabial folds, the honest answer starts with understanding why they form.

Smile Lines vs Nasolabial Folds — Are They the Same Thing?

Yes. Smile lines, laugh lines, laughter lines and nasolabial folds all describe the same anatomical feature. “Nasolabial fold” is simply the clinical term, from naso (nose) and labial (lip).

There is one distinction worth making, though. Marionette lines are not the same thing. Those run downward from the corners of the mouth toward the jawline, and although they often appear alongside nasolabial folds, they are a different problem with different treatment — see marionette lines.

Why Nasolabial Folds Deepen

The nasolabial fold sits at the natural junction between the cheek and the upper lip, where two structurally different tissue compartments meet. In youthful faces it is barely visible at rest, because the cheek volume above it is full and tents smoothly over the underlying support.

This is the point most articles miss, and it changes everything about treatment. The fold is not a crease that forms in the skin. It is a boundary that becomes conspicuous when the tissue above it drops. Treating the line itself, in isolation, addresses the symptom rather than the cause.

The anatomy

Levator labii superioris — the muscle that raises the upper lip. When it contracts during smiling it pulls the lip upward and outward, deepening the fold.

Zygomaticus major — the main smile muscle, running from the cheekbone to the corner of the mouth. Its contraction creates the dynamic component of the fold.

Subcutaneous fat compartments — the malar (cheek), nasolabial and superficial buccal fat pads provide the volume determining how the fold sits at rest. Loss or descent of these is the single biggest factor in how deep it becomes with age.

Supportive ligaments — the zygomatic-cutaneous ligament and others anchor the cheek to underlying bone. When these stretch, cheek tissue descends and the fold is accentuated. The same descent produces sagging jowls further along the jawline.

What Causes Nasolabial Folds to Get Worse

Volume loss is the primary driver. From the mid-thirties onward the cheek fat compartments thin and descend. The midface deflates, supportive structures relax, and the fold deepens. Our guide to facial ageing over time sets out what happens decade by decade.

Genetics set how prominent the fold is to begin with. Some people have visible nasolabial folds in their twenties, others only in their fifties.

Sun exposure accelerates the loss of dermal collagen and elastin, and the midface takes a significant share of cumulative UV damage.

Smoking compounds volume loss with vascular impairment and direct collagen damage.

Weight loss — and this surprises people. Losing a significant amount of weight usually makes nasolabial folds more noticeable, not less. Facial fat goes with the rest, so the cheek deflates while the skin that contained it does not shrink to match. The fold that was being propped up from above becomes a fold with nothing behind it. This is one reason people finishing a major weight-loss journey are often dismayed by their face, and why facial changes after weight loss deserve planning rather than surprise.

Repeated weight fluctuation is worse still, stretching and recoiling the skin until its elastic recovery is diminished.

Sleep position contributes to asymmetric folds in people who consistently sleep on one side — a common cause of the facial asymmetry people notice in photographs.

Repetitive facial movement plays a part, particularly in very expressive faces, but is rarely the dominant factor.

Nasolabial Fold Filler — Where It Should Actually Go

For most people, hyaluronic acid dermal fillers are the most effective non-surgical treatment. There are two complementary techniques, and the order matters.

Technique one — restore the cheek

Filler is placed in the cheek and zygomatic area to rebuild lost volume. By restoring structural support above the fold, descended tissue is lifted off the lip and the crease flattens indirectly. This produces the most natural result because it treats the cause.

Technique two — soften what remains

A small amount of filler placed precisely within the line itself softens whatever is still visible after the cheek has been restored. This is done second, not first. Treating the cheek often reduces how much direct fold filler is needed — sometimes to none.

Why the order matters so much

Filling the fold without restoring the cheek can produce an unnatural, sausage-like ridge — the line is filled but the face still looks deflated, and the filled crease sits oddly on a flat midface. It is the simplest treatment to deliver and the easiest for an inexperienced injector to perform, which is why it is so widely advertised.

There is also a safety argument for who injects this area, not just how. The nasolabial fold sits directly over the angular artery, which connects upward to the ophthalmic artery. A review of visual loss following cosmetic filler injection identifies the nasolabial fold and nasal dorsum as sites where filler entering the anastomosis between the dorsal nasal, angular and lateral nasal arteries can travel backwards into the ophthalmic circulation, and concludes that injection force and velocity should be kept as gentle and slow as possible (Annals of Plastic Surgery, 2015). Blindness from filler is genuinely rare, and we are not raising it to alarm anyone — but it is the reason this area warrants an injector who knows the vascular anatomy, uses a cannula where appropriate, aspirates, and has hyaluronidase on the premises.

Hyaluronic acid is the standard product for this area. It integrates well with surrounding tissue, holds shape predictably for 9 to 18 months, and can be dissolved with hyaluronidase if the result is not what was wanted. Products used in this area include Juvéderm and Restylane, both well-established HA ranges.

On the day: 30 to 45 minutes including a 15-minute wait for topical anaesthetic. The product contains lidocaine. A needle or blunt cannula is used depending on the area. Results are visible immediately, with mild swelling settling over a week.

Too Much Filler in Nasolabial Folds: What Overfilling Looks Like

Overfilling this area is common enough to have a recognisable look, and it is worth knowing the signs before you book — both so you can avoid it and so you can identify it if it has already happened.

• A visible ridge or sausage along the line. The crease is gone but a raised tube of product sits where it used to be, most obvious in side lighting or when the face is relaxed.
• A heavy, shelf-like upper lip area. Product placed too superficially or too generously weighs the tissue down instead of lifting it.
• A bluish tinge along the fold. Known as the Tyndall effect, this happens when hyaluronic acid sits too close to the surface and scatters light.
• Puffiness that worsens over years, not months. Hyaluronic acid attracts water, and repeated top-ups in the same plane can accumulate well beyond the stated duration.
• A face that looks fuller but not younger. The most common outcome of treating the line instead of the midface.

All of it is reversible. Hyaluronic acid can be dissolved with hyaluronidase, usually in one or two sessions, and it is often worth dissolving completely and starting again rather than adding more product to correct the balance. If you have had repeated filler here over several years and are unsure what is product and what is you, dissolving is the only way to find out.

Nasolabial Folds Treatment by Severity

Skincare and lifestyle

Skincare does not reverse established folds but slows progression. Daily broad-spectrum SPF is the highest-impact single intervention. Topical retinoids build dermal collagen over time; vitamin C supports collagen synthesis. Stopping smoking and maintaining a stable weight matter substantially.

Anti-wrinkle injections — a limited role

Anti-wrinkle injections can soften the contribution of levator labii superioris where the fold has a strong dynamic component, but doses are very small and the technique demanding. Over-treatment can flatten the smile or affect upper-lip function. For most people this is not the right primary treatment.

Energy-based treatments — for skin quality

Fotona 4D and Morpheus8 stimulate dermal collagen. They do not eliminate established folds but improve texture and give modest tightening — best as a complement to filler, not a replacement. See facial skin tightening treatments for the full comparison.

Biostimulators

Profhilo and polynucleotide treatments improve dermal quality and hydration, supporting the foundation filler then sits on. People with poor skin quality may benefit from this preparation first.

Fat transfer

Facial fat transfer uses your own fat, re-injected into the midface. The surviving fraction is permanent and integrates fully with surrounding tissue, though not all of it survives. Often combined with facelift surgery.

Surgery — when descent is significant

Where the fold has deepened alongside jowling and visible cheek descent, surgery is more effective than continuing non-surgical maintenance.

A facelift repositions the descended SMAS and overlying tissue, lifting the midface back toward its original position — addressing the structural cause rather than masking it. A mini facelift focuses on the lower cheek and jawline, suiting moderate descent. Which is appropriate depends on how much tissue has actually moved — see facelift age for how this is assessed.

How to Get Rid of Smile Lines and Nasolabial Folds — The Honest Answer

You cannot get rid of them, and you should not want to. Everyone has nasolabial folds. Newborns have them. They are the anatomical boundary between two parts of the face that move differently, and a face without them looks wrong rather than young.

What can be achieved is softening — restoring the volume that has been lost, repositioning what has descended, and improving the skin quality that makes the shadow more pronounced. A good result leaves a fold that reads as a normal feature rather than a line that ages you.

Beware anyone promising elimination. The over-filled midface, where the fold has been chased with product until the cheeks look inflated, is a far more ageing look than the fold ever was.

Combining Treatments — The Typical Plan

For most people in their late thirties to fifties, the most natural result comes from combination rather than a single treatment:

• Cheek filler to restore midface volume
• A small amount within the fold itself, only if needed afterwards
• Anti-wrinkle treatment for adjacent dynamic lines for overall balance
• Daily SPF and a topical retinoid
• Energy-based treatment annually if skin quality is a concern

Where descent is significant, the conversation shifts toward surgical assessment. Beyond facelift and fat transfer, two further options are sometimes raised: a mid-facelift or cheek lift, which repositions the descended cheek pad rather than adding volume to it, and cheek augmentation with implants, which adds permanent projection over the cheekbone. Implants change the skeletal platform and are better suited to patients whose midface was flat to begin with than to those whose cheek has descended with age — adding projection to a descended cheek can accentuate the fold rather than soften it.

If you want to see what realistic change looks like before committing, our before and after photo gallery includes midface and facelift cases.

Cost

Filler is priced per syringe, with most people needing 1 to 2 syringes for cheek restoration plus a smaller amount for the fold if required. Surgical options vary substantially by procedure — see facelift cost. Finance through Chrysalis Finance is available across all treatment types, subject to status.

Nasolabial Folds at Centre for Surgery

We assess the midface as a whole rather than treating the line in isolation, and we will tell you where filler will help and where it will not. Treatment is provided at our CQC-registered facility on Baker Street, rated Good overall, by practitioners with detailed knowledge of facial vascular anatomy and immediate access to hyaluronidase.

You can read verified feedback on Google Reviews, or on our own patient reviews page, which brings together verified reviews from Google and Trustpilot.

• Phone: 020 7993 4849
• Email: contact@centreforsurgery.com
• Address: 95-97 Baker Street, London W1U 6RN

Nasolabial Folds: Frequently Asked Questions

Related Articles

• Marionette Lines — Causes and Treatments
• The Best Treatment for Sagging Jowls
• Facial Ageing Over Time
• Sunken Cheeks — Causes and Treatments
• Facial Skin Tightening Treatments

---

Centre for Surgery · CQC-regulated · GMC-registered surgeons · 95–97 Baker Street, Marylebone, London W1U 6RN · 020 7993 4849 · Book a consultation · Finance available, subject to status