Understanding Nasolabial Fold Treatments

Nasolabial folds, the lines running from the sides of the nose to the corners of the mouth, are one of the most common concerns patients bring to aesthetic clinics. Often called “smile lines,” these creases are natural facial features, but their deepening over time can create an aged or tired appearance. Modern aesthetic medicine offers several evidence-based approaches to soften these folds.

Why do nasolabial folds develop?

Several factors cause nasolabial folds to deepen over time:

• Volume loss: Malar fat pads in the mid-face gradually descend and diminish
• Collagen degradation: The dermal collagen network weakens, reducing skin firmness
• Bone resorption: The maxillary bone recedes, reducing skeletal support
• Muscle activity: Repeated facial expressions crease the skin along these natural lines
• Gravity: Over decades, gravitational pull contributes to tissue descent
• Sun damage: UV exposure accelerates collagen breakdown and skin laxity

Understanding the underlying cause of each patient’s nasolabial folds is critical to selecting the right treatment approach. A fold caused primarily by volume loss requires a different strategy than one caused by skin laxity.

Treatment Options

1. Dermal Fillers

Hyaluronic acid dermal fillers remain the gold standard. Products such as Juvederm Volift, Restylane Defyne, and Teoxane RHA 3 are specifically designed for this area. A 2020 systematic review in Dermatologic Surgery found that HA fillers achieved significant improvement with satisfaction rates exceeding 85% and results lasting 9-18 months.

2. Mid-face volume restoration

Rather than filling the fold directly, many practitioners address the root cause by restoring volume to the cheeks. By replacing volume in the mid-face, the tissue is lifted, naturally softening the fold from above.

Treating the cheeks to improve nasolabial folds may seem counterintuitive, but it’s often the most effective approach.

3. Collagen-stimulating treatments

• Poly-L-lactic acid (Sculptra): Triggers collagen production over 2-3 months, lasting up to 2 years
• Calcium hydroxylapatite (Radiesse): Provides immediate volume plus long-term collagen stimulation
• Microneedling with growth factors: Stimulates collagen remodelling in the fold area

4. Energy-based devices

• Radiofrequency skin tightening: Devices like Morpheus8 deliver controlled heat to stimulate collagen
• Ultrasound therapy (HIFU): Targets deep facial tissues for a lifting effect
• Fractional laser: Improves skin texture and stimulates collagen production

5. Thread Lifts

PDO or PLLA threads placed in the mid-face provide mechanical lifting and collagen stimulation, working well alongside filler treatments.

Treatment selection guide

• Volume loss (30s-40s): Mid-face filler + direct fold treatment
• Skin laxity (50s+): Energy-based devices + biostimulators
• Deep static fold: Robust HA filler or calcium hydroxylapatite
• Fine dynamic lines: Superficial HA filler + skincare regime

Realistic Expectations

Complete elimination is neither achievable nor desirable, some degree of fold is natural and necessary for normal facial expression. The goal is to restore a more youthful, refreshed appearance whilst maintaining natural movement.

Risks and Considerations

The nasolabial region has a rich blood supply, making vascular complications a rare but serious risk. All reputable practitioners carry hyaluronidase and follow established safety protocols.

Frequently asked questions

At what age should I start treating nasolabial folds?

There is no specific age, it depends on when the folds begin to bother you. Some patients notice deepening in their late 20s, whilst others do not seek treatment until their 50s. Early intervention can slow progression.

How much filler is needed for nasolabial folds?

Typically, 0.5-1ml per side is used for the folds directly. If mid-face restoration is included, an additional 1-2ml may be needed for the cheeks. Your practitioner will recommend the appropriate amount.

Do nasolabial fold treatments look natural?

When performed by a skilled practitioner using appropriate products and volumes, results are very natural. A conservative, staged approach is recommended, it is always possible to add more at a follow-up.

Can I prevent nasolabial folds from getting worse?

Yes. Consistent sun protection, retinoid-based skincare, maintaining a stable weight, and not smoking all help slow progression. Sleeping on your back can also reduce compression-related deepening.