Nasolabial folds are the two creases that run from each side of your nose down to the corners of your mouth. Everyone has them. They’re a normal part of facial anatomy, visible when you smile and, over time, becoming more prominent even at rest. Sometimes called “smile lines” or “laugh lines,” they mark the boundary between your cheeks and your upper lip.
What Creates the Fold
The nasolabial fold isn’t just a wrinkle in the skin. It’s a structural feature shaped by the interaction of fat, muscle, and bone beneath the surface. Several muscles that lift your upper lip, including the ones you use to smile, attach to the skin right along this crease. Every time you make an expression, those muscles pull along the same line, reinforcing the fold over years of use.
The tissue on either side of the fold behaves differently. Below the crease, skin is firmly anchored to the muscle around your mouth, so it stays relatively taut. Above the crease, the connection is much looser. A pad of fat sits in this area, and because it’s not tightly secured, gravity gradually pulls it downward. This creates the characteristic look of fullness or puffiness on the cheek side of the fold, with a visible drop-off at the crease itself.
Why They Deepen With Age
As you age, two things happen simultaneously in this area. The fat above the fold tends to enlarge and sag, while the fat below it thins out. This growing contrast in tissue thickness on either side of the crease is what makes the fold look deeper and more pronounced. At the same time, your skin is losing the structural proteins that keep it firm and elastic. With less of that internal scaffolding, the skin can’t resist the downward pull of gravity as effectively.
Bone loss also plays a role. The upper jawbone gradually shrinks with age, reducing the support structure underneath the cheek. When the foundation recedes, the soft tissue above it has less to cling to, and the fold deepens further.
Skin Tone, Ethnicity, and Timing
Not everyone develops prominent nasolabial folds on the same timeline. Structural differences in skin thickness, composition, and pigmentation all influence when these folds become noticeable. Research comparing facial aging across skin types has found that Caucasian volunteers had measurably larger nasolabial folds than Black African volunteers across every parameter tested: length, surface area, depth, and volume. This aligns with the broader observation that visible photoaging in darker skin tones often doesn’t appear until the late fifties or sixties, while it tends to show up earlier in lighter skin.
Genetics, facial bone structure, and the amount of natural fat padding in your cheeks all contribute to individual variation. Some people have barely visible folds well into middle age, while others notice them in their late twenties.
Smoking and Sun Exposure Speed Things Up
Two external factors accelerate the deepening of nasolabial folds more than almost anything else: smoking and UV exposure. Smoking suppresses the production of collagen and elastin, the proteins responsible for keeping skin firm and stretchy. Smokers have fewer of these fibers in their skin, which makes it slacker and less resilient. One study found that the surface area of nasolabial folds was significantly larger in smokers compared to non-smokers.
The combination of smoking and cumulative sun exposure is particularly damaging. UV radiation breaks down existing collagen while smoking prevents the body from replacing it efficiently. Together, they create a compounding effect that can make folds appear years ahead of schedule.
Topical Products: What Actually Works
Retinol is the most studied topical ingredient for nasolabial folds, and it does produce measurable results, though the improvements are modest. In one clinical trial, treatment with retinol over 11 weeks noticeably improved the appearance of nasolabial folds. When retinol was paired with a plant-based booster formula, the improvement in fold length more than doubled compared to retinol alone.
The catch is that nasolabial folds are a deeper structural issue than fine surface wrinkles. Topical products can improve skin texture and mildly reduce fold visibility, but they can’t address the sagging fat pads or bone loss underneath. If your folds are shallow, consistent retinol use and daily sunscreen are reasonable first steps. If they’re deep, topical treatments alone are unlikely to produce dramatic changes.
Dermal Fillers
Injectable fillers made of hyaluronic acid are the most common professional treatment for nasolabial folds. They work by adding volume directly beneath the crease, physically plumping the area to reduce the depth of the fold. Results are immediate and typically last several months, though longevity varies by product. In one study tracking two different hyaluronic acid fillers over 48 weeks, both showed measurable increases in skin thickness at the injection site, but the effect had diminished significantly by the end of that period. Some fillers held up better than others, suggesting that the specific product your provider chooses matters.
Fillers do carry a small but real risk of vascular complications. The nasolabial area sits near the facial artery and its branches. If filler is accidentally injected into or compresses a blood vessel, it can block blood flow, potentially causing skin damage. Large studies estimate this happens in roughly 1 out of every 6,600 filler injections across all facial areas. The risk is low but not zero, which is why provider experience and anatomical knowledge matter.
Energy-Based Treatments
Radiofrequency devices heat the deeper layers of skin to stimulate collagen production and tighten tissue. For nasolabial folds specifically, research shows that two treatment sessions spaced a month apart produce significantly better results than a single session. Improvement continues to build between the first and fourth months after treatment, meaning the full effect isn’t visible right away.
These treatments work best for mild to moderate laxity. They won’t match the results of fillers for deep folds, but they offer a non-injectable option that gradually improves skin firmness over time.
Surgical Approaches
For pronounced nasolabial folds, surgical options include various types of facelifts and fat grafting. The results and longevity depend heavily on the technique. Many common facelift methods, such as those that rely on stitches and skin tension to hold tissue in place, tend to lose their effect once the sutures loosen or the skin stretches again. Deep-plane techniques that lift skin and underlying tissue together also face recurrence once the skin relaxes postoperatively.
A more targeted approach involves reshaping the specific fat pad that sits along the fold, using sutures to reposition it without putting tension on the skin. Because this technique doesn’t depend on skin tension to maintain the lift, it may produce longer-lasting results. Bone augmentation of the upper jaw with implants or other materials has also been used to rebuild the lost skeletal support underneath the cheek, with good long-term outcomes for the nasolabial crease.
Fat grafting, where fat is harvested from another part of your body and injected into the fold area, provides a natural-feeling volume boost. Like synthetic fillers, some of the transferred fat is reabsorbed over time, so results are semi-permanent rather than permanent.