Nasolabial folds: why they deepen and the non-surgical options a doctor considers

Nasolabial folds are the two lines that run from the sides of the nose to the corners of the mouth. Everyone has them, from childhood, because they mark where the cheek meets the upper lip. What changes with age is how deep they look, and that is what treatment can sometimes soften. It cannot remove the fold itself, and a face without one would not look natural.

This guide covers why the folds deepen, how a doctor works out which cause is behind yours, the non-surgical options considered for each cause, the risks, and when surgery is the more honest answer.

Key takeaways

• The fold is normal anatomyIt marks where the cheek meets the lip. Treatment aims to soften a deepened fold, not erase it.

• The cause decides the planLost volume, descended cheek tissue and loose skin each call for a different approach.

• Support usually goes above the foldFilling the line itself is often not the answer, because the problem sits higher in the cheek.

• This area carries real filler riskBlood vessels run close to the fold, so who injects and how matters.

Why do nasolabial folds get deeper?

Volume loss and cheek fat descent

The fat under the skin of the face sits in separate compartments rather than one sheet, a finding described by Rohrich and Pessa in Plastic and Reconstructive Surgery. With age, the deeper cheek compartments lose volume and the tissue above the fold sits lower. The cheek then rests against the fold, which makes the line look deeper even when the fold itself has not changed much.

Skin laxity

Skin makes less collagen and elastin over time, so it holds its shape less firmly. Looser skin folds more readily at a natural crease.

Sun, smoking and weight change

Long-term sun exposure and smoking both speed up the breakdown of collagen. Large changes in weight, up or down, alter how much support the mid-face has. These do not cause the fold, but they influence how early and how much it deepens.

How a doctor works out which cause is yours

A simple check helps: lie down and look in a mirror, or lift your cheek gently upwards and outwards with a fingertip. If the fold softens a lot, descended or deflated cheek tissue is a large part of it. If it barely changes, skin quality and an etched crease may matter more.

At a consultation the doctor looks at the whole mid-face, not just the line, because the fold is usually a sign of what is happening above it. This is the same reasoning used on our fine lines and wrinkles page, where folds are treated as a support problem rather than a wrinkle.

Non-surgical options, matched to the cause

Many plans combine more than one, and staged sessions are common. Which suits you, and in what order, is decided at assessment.

Dermal fillers

Fillers are hyaluronic acid gels placed by a doctor to add volume or support. For the nasolabial area, the doctor often restores support in the mid-cheek first, because filling the line directly can look heavy if the cause sits higher. Hyaluronic acid filler is gradually broken down by the body.

Bio-stimulators

Collagen-stimulating injectables work more gradually than fillers and are planned as part of a course. They cannot be dissolved, so they are planned carefully. Our Sculptra vs Radiesse guide explains how the two differ.

Energy-based lifting and firming

Focused ultrasound (HIFU and Ultherapy) and radiofrequency deliver heat into deeper layers of skin and are used for laxity rather than volume loss. They suit some people with early laxity, and they do not replace volume that has been lost.

Risks you should know about

Other risks include bruising, swelling, lumps or nodules, infection and allergic reactions. Bio-stimulators carry a recognised risk of delayed nodules. Energy-based treatments can cause temporary redness, swelling or tenderness. Your doctor will explain the risks for the specific treatment before you consent.

When surgery is the more honest route

When the skin and tissue have descended significantly, non-surgical treatments may soften the fold only a little, and adding more filler to compensate tends to make the face look heavy rather than refreshed. In that situation a doctor should tell you that a surgical opinion from a plastic surgeon may serve you better. A good consultation includes that answer when it is the right one.