Aesthetic Treatments for Nasolabial Folds

Nasolabial Folds: Understanding and Treating Smile Lines

Nasolabial folds — the creases running from each side of the nose to the corners of the mouth — are among the most common concerns bringing patients to aesthetic clinics. Often called “smile lines” or “laugh lines,” these folds deepen progressively with age due to a combination of volume loss, skin laxity, and gravity. While some degree of nasolabial fold is normal (even in young faces), deepening folds can create a tired, aged, or unhappy appearance that doesn’t reflect how a person feels inside.

At Axiom Aesthetics, we take a holistic approach to nasolabial fold treatment, addressing the underlying causes rather than simply filling the crease, to achieve natural, long-lasting results that maintain facial animation.

Why Nasolabial Folds Deepen with Age

Understanding the multifactorial aetiology of nasolabial folds is essential for effective treatment:

Volume Loss

The primary driver of nasolabial fold deepening is midface volume loss. The malar fat pad — a triangular fat compartment over the cheekbone — descends and deflates with age, creating a “curtain” of tissue that falls forward and deepens the nasolabial crease. Research in Plastic and Reconstructive Surgery (2022) demonstrated that midface volume restoration reduces nasolabial fold depth more effectively than direct fold treatment alone.

Skin Laxity

Collagen and elastin degradation leads to skin that can no longer maintain its youthful position against gravitational forces. The skin of the cheek gradually slides downward, bunching at the nasolabial fold.

Bone Resorption

Age-related resorption of the maxillary bone (upper jaw) reduces the skeletal support for overlying soft tissue. This particularly affects the pyriform aperture (nasal opening area), contributing to fold deepening near the nose.

Muscle Activity

The levator labii superioris and zygomaticus muscles create dynamic folding during facial expression. Over decades of repeated movement, the fold becomes etched into the skin even at rest.

Treatment Approaches: From Conservative to Comprehensive

Direct Fold Treatment: Dermal Fillers

The most straightforward approach is direct injection of dermal filler into the nasolabial fold:

• Product selection — medium-viscosity HA fillers (Juvederm Volift, Restylane, Teoxane RHA 3) provide optimal support with natural movement
• Technique — linear threading or serial puncture technique along the fold; typically 0.5–1ml per side
• Results — immediate improvement lasting 9–18 months
• Limitations — direct filling alone does not address the underlying volume loss causing the fold; overfilling can create an unnatural “moustache” appearance

Midface Volume Restoration (The Preferred Approach)

Experienced practitioners recognise that treating the cause (midface deflation) is often more effective than treating the symptom (the fold):

• Cheek augmentation — restoring malar volume with HA fillers (Juvederm Voluma) or bio-stimulators lifts the descending tissue, naturally reducing the nasolabial fold
• Combination approach — midface restoration plus conservative direct fold treatment produces the most natural results
• Typical volumes — 1–2ml per cheek plus 0.5ml per nasolabial fold

Skin Quality Treatments

• Skin boosters (Profhilo) — improve skin quality and mild laxity in the lower face
• Microneedling or RF microneedling — stimulate collagen to improve skin firmness over the fold
• Fractional laser — can improve fine lines within the fold but does not address volume loss

Thread Lifts

Absorbable sutures (PDO, PLLA, or PCL threads) placed in the midface can mechanically lift descending tissue and stimulate collagen production along the thread pathway. Appropriate for mild to moderate nasolabial folds with associated midface descent.

Energy-Based Tightening

• Ultrasound (Ultherapy) — non-surgical lifting that can reduce fold depth by tightening midface skin
• Radiofrequency — skin tightening that may modestly improve fold appearance

What NOT to Do: Common Treatment Mistakes

• Overfilling the fold directly — creates an unnatural, puffy appearance and can be more ageing than the fold itself
• Ignoring the midface — treating only the fold without addressing volume loss is like smoothing a curtain without raising it
• Using too-firm products — the nasolabial area is highly mobile; overly rigid fillers can create visible lumps during facial animation
• Attempting complete elimination — some nasolabial fold is normal and natural; attempting to fully eliminate it creates an uncanny, unnatural appearance

Results and Expectations

Realistic expectations are key to patient satisfaction. Effective nasolabial fold treatment should:

• Soften the fold without eliminating it completely
• Maintain natural facial expression and animation
• Create a refreshed, rested appearance rather than an obviously “done” look
• Improve progressively over 2–4 weeks as any swelling resolves
• Last 9–18 months depending on products used and individual metabolism

Frequently Asked Questions

Is nasolabial fold filler painful?

Most patients describe mild discomfort rather than pain. Modern HA fillers contain lidocaine, and topical anaesthetic is typically applied beforehand. The area may be tender for 24–48 hours after treatment.

Can filler migrate from the nasolabial folds?

With proper technique and appropriate product selection, migration is uncommon. Using the correct viscosity filler and placing it at the right depth minimises this risk. Excessive volume increases migration potential.

Why do some people’s nasolabial folds come back quickly?

Individuals with strong facial expressions (big smilers) metabolise filler faster in this area due to constant muscle activity. High metabolic rates and active lifestyles also contribute. For these patients, slightly firmer fillers or combination approaches with midface support may extend results.

At what age should I start treating nasolabial folds?

There is no specific age threshold. Treatment is appropriate when the folds bother you. Some patients seek treatment in their 30s for early deepening, while others wait until their 50s or 60s. Early preventative approaches (skincare, sun protection, midface support) can slow fold progression.

This article is for informational purposes only and does not constitute medical advice. Always consult a qualified aesthetic practitioner for personalised assessment and treatment. Individual results may vary.