Nasolabial folds are the creases that run from the sides of the nose to the corners of the mouth. Everyone has them to some degree, as they mark the natural boundary between the cheek and the upper lip. They deepen with age as the cheek fat descends and loses volume. Mild folds can be softened with filler or by supporting the cheek; deep folds caused by sagging often respond best to a facelift.
Why everyone has them
The nasolabial fold is a normal anatomical landmark. The muscles that lift the upper lip when smiling attach to the skin along this line, and the fat of the cheek sits above and outside it. Children and young adults show a fold when they smile, and some people have a visible crease at rest from a young age, particularly if they have full cheeks or are very expressive. The goal of treatment is to soften a deep fold, not to erase it, as a face with no fold at all looks unnatural.
Why they deepen with age
- Cheek descent: as the cheek fat slides downward and forward, it piles up against the fold, making it deeper and heavier.
- Volume loss: the deep cheek fat and the bone near the side of the nose lose some support.
- Skin laxity: thinner, less elastic skin creases more easily.
- Expression: years of smiling and laughing reinforce the line.
- Weight change: both weight loss and weight gain can make the folds more prominent.
Nasolabial folds and marionette lines
Nasolabial folds sit above the mouth corners, while marionette lines run below them towards the jaw. Both develop through similar processes and often appear together with jowls. Assessing the whole lower face helps ensure that treating one line does not leave another more obvious.
Treating the cause, not just the line
A deep nasolabial fold is often a sign of what is happening higher in the cheek. Filling the fold directly can help mild creases, but in many people the more effective and natural approach is to restore support over the cheekbone, which lifts tissue away from the fold. Where the cheek has descended significantly, repositioning it surgically usually has more impact than adding filler into the line.
Non-surgical options
Hyaluronic acid dermal filler can be placed in the cheek to provide lift, directly into the fold to soften it, or both. Results are temporary and usually last many months. Skin quality treatments and sun protection help with fine surface creasing. Risks of filler in this area include bruising, swelling, lumps and, rarely, blockage of a blood vessel, as an important artery runs close to the fold, so treatment must be performed by an experienced medical practitioner. Overfilling the fold can make the upper lip area look bulky.
Surgical options
A facelift, and in particular a deep plane facelift, can reposition the cheek fat upward, which often softens deep nasolabial folds noticeably. A mini facelift has less effect on the mid-face and tends to improve the jowl more than the fold. Fat grafting can restore volume alongside a lift. Mr Nassab will explain how much improvement is realistic, as some fold usually remains after surgery and that is part of a natural result.
Recovery and cost
Filler involves minimal downtime, with any swelling or bruising usually settling within days. After a facelift, most people need two to three weeks before feeling comfortable socially. Filler is quoted at consultation. A facelift costs from £14,500. A deep plane face and neck lift costs from £18,500 and a mini facelift from £8,000. The £150 consultation fee is separate. Treatments are only for adults aged 18 and over.
Frequently Asked Questions
Are nasolabial folds normal?
Yes. Everyone has them to some extent. They usually become more noticeable with age.
Is filler the best treatment for nasolabial folds?
Filler can work well for mild to moderate folds, often by supporting the cheek. Deep folds from sagging usually respond better to a surgical lift.
Will a facelift remove nasolabial folds?
A facelift can soften them, particularly a deep plane technique, but a natural fold will remain.
Can smile lines be softened without looking frozen?
Yes. Filler and surgical lifting target the fold without affecting how you smile.
Why is one nasolabial fold deeper than the other?
Natural asymmetry, sleeping position and differences in cheek volume or descent can make one side more pronounced. This is taken into account when planning treatment.
How long does filler last in the nasolabial folds?
Typically many months, depending on the product, the amount used and how active the area is. Top-up treatments are needed to maintain the effect.
