What Are Nasolabial Folds?
Nasolabial folds are the creases that run from both sides of the nose to the corners of the mouth, often called smile lines or laugh lines. They are very common in men and women of all races, especially with age.
In younger people, the folds may show only when smiling or laughing. Over time, they can become deep, permanent creases that show even at rest.
Nasolabial Folds at a Glance
| Also called | Smile lines, laugh lines |
|---|---|
| Main causes | Aging (less collagen, elastin and cheek volume), sun damage, smoking and large weight changes |
| Who gets them | Very common in men and women of all races, especially with age |
| Is it serious? | No. They are a common sign of aging, and treatment is a personal choice. |
| Diagnosis | No tests. A clinician looks at the face. |
| Treatment | Dermal fillers, botulinum toxin, retinoids, skin tightening, or a cheek lift or facelift |
| Insurance | Treatment that reduces signs of aging is not covered |
What Causes Nasolabial Folds to Deepen?
Nasolabial folds deepen mainly with aging, and sun damage, smoking and weight changes can make them more noticeable:
- Aging skin: cheekbones can flatten, gravity pulls loose skin down, and skin has less collagen and elastin.
- Cheek volume loss: facial fat sits in separate compartments. Cadaver studies suggest that losing deep cheek fat leaves excess skin and makes the fold look more prominent.
- Sun and smoking: both break down collagen and elastin.
- Weight loss or gain: looser skin, or fuller cheeks, can accentuate the folds.
How Are Nasolabial Folds Assessed?
Nasolabial folds are diagnosed by looking at the face; there are no tests, and whether to treat them is your choice. Because several causes can shape a fold, a clinician looks for what drives yours, such as lost cheek volume or loose skin. Tell your clinician about past cosmetic treatments and any blood-thinning medicines or supplements, which raise the risk of bruising.
How Are Nasolabial Folds Treated?
Nasolabial folds can be softened with dermal fillers, botulinum toxin, retinoids, skin tightening or surgery.
Dermal Fillers
The FDA has approved dermal fillers for adults 22 and older. Absorbable (temporary) fillers are approved for moderate to severe folds such as nasolabial folds, and non-absorbable (permanent) fillers only for nasolabial folds and cheek acne scars. Filler can go directly into the fold or into the deep cheek to restore volume above it.
Most treatments take 15 to 30 minutes in one office visit. Hyaluronic acid results are immediate; poly-L-lactic acid takes 2 or 3 weeks. Most people return to everyday activities right away but should wait until the next day to exercise.
| Filler type | How long it typically lasts |
|---|---|
| Hyaluronic acid gel | 4 to 12 months |
| Calcium hydroxylapatite | 6 months to 1 year |
| Poly-L-lactic acid | 1 to 3 years |
| PMMA | Permanent |
Other Options
- Botulinum toxin: relaxes a muscle that contributes to the fold, for a few months.
- Retinoids: promote collagen and can reduce lines over time. Skin-firming creams give subtle results at best.
- Skin tightening: ultrasound, radiofrequency or lasers stimulate collagen.
- Surgery: a cheek lift or facelift repositions skin and underlying tissue.
Risks of Fillers
Redness, swelling, tenderness and occasional bruising tend to clear within 7 to 14 days. Lumps (nodules), infection and allergic reaction are less common. The most concerning risk is filler entering a blood vessel; the chance is low, but it can cause tissue death, blindness or stroke. Hyaluronic acid filler can be dissolved with the enzyme hyaluronidase, but permanent and other fillers may be difficult or impossible to remove.
Filler safety is unknown during pregnancy or breastfeeding, under age 22, or in people prone to keloid scars. Treatment should be delayed if you have a skin infection or active rash or pimples.
Can You Prevent Nasolabial Folds?
Nasolabial folds can't be prevented permanently, but habits can delay them and make them less prominent:
- Wear SPF 30 or higher sunscreen daily, and reapply every two hours, more often if sweating or swimming.
- Don't tan in the sun or in tanning beds.
- Quit smoking, or don't start.
- Avoid skin products that sting or burn unless prescribed.
- Sleep on your back, or switch sides often.
When Should You See a Clinician About Nasolabial Folds?
See a clinician about nasolabial folds when they bother you and you want to discuss treatment. After filler, seek emergency care for unusual pain, vision changes, white, gray or blue skin near the injection, or signs of stroke. Call your provider about lumps or other side effects, which can appear weeks, months or years after treatment.
Nasolabial Folds vs. Marionette Lines
Nasolabial folds run from the nose to the corners of the mouth, while marionette lines run from the mouth corners down to the chin, below the nasolabial folds.
| Nasolabial folds | Marionette lines | |
|---|---|---|
| Location | Sides of the nose to the corners of the mouth | Corners of the mouth down to the chin |
| Also called | Smile lines, laugh lines | Melomental folds |
| Common treatments | Fillers, botulinum toxin, retinoids, skin tightening, surgery | Fillers, Botox, peels, laser resurfacing, microneedling, thread lift, facelift |
Nasolabial Fold Evaluation at GENEVA
At GENEVA Primary Care & Med Spa in Alpharetta, GA, a provider evaluates your nasolabial folds, goals and health history. Your provider then recommends treatment at GENEVA or a referral to a specialist, such as a dermatologist or plastic surgeon.
You can read about dermal fillers and laser skin tightening before your visit. GENEVA serves patients from Alpharetta, Johns Creek, Milton, Roswell and Cumming.
Related Terms
- Dermal Fillers
- Hyaluronic Acid Filler
- Marionette Lines
- Cheek Augmentation
- Hyaluronidase
- Sculptra
- Aging Skin
Nasolabial Folds FAQs
Are nasolabial folds normal?
Yes. Nasolabial folds are very common in men and women of all races, especially with age. Young people often see them only when smiling or laughing. Over time, they can become deep creases that stay even when the face is relaxed, and they may be symmetrical or asymmetrical. There's no way to prevent them permanently, but daily sunscreen and not smoking can help delay them. Treatment is a personal choice; if they bother you, a clinician can explain options.
What causes nasolabial folds to get deeper?
Nasolabial folds deepen mainly with aging, as skin loses collagen and elastin, cheekbones flatten and gravity pulls loose skin down. Cadaver studies suggest that losing deep cheek fat makes the fold look more prominent. Sun exposure and smoking both break down collagen and elastin. Large weight loss can leave looser skin, and weight gain can enlarge the cheeks; both can accentuate the folds. Daily sunscreen and not smoking can help delay deeper folds.
What is the best treatment for nasolabial folds?
No single treatment is best for everyone with nasolabial folds. Dermal fillers are one option, and the FDA has approved them for moderate to severe folds in adults 22 and older. Filler can be placed in the fold or in the cheek to restore lost volume. Other options include botulinum toxin, retinoids, skin tightening with ultrasound, radiofrequency or lasers, and a cheek lift or facelift. The right choice depends on what is causing your folds, so start with an in-person evaluation.
How long does filler last in nasolabial folds?
Filler in the nasolabial folds lasts from about 4 months to 3 years, depending on the material, and PMMA is permanent. The American Academy of Dermatology lists hyaluronic acid gel at 4 to 12 months, calcium hydroxylapatite at 6 months to 1 year and poly-L-lactic acid at 1 to 3 years. The FDA notes duration also depends on the injection site. Most fillers are temporary, so repeat treatments are needed to keep the effect. Ask how long your recommended filler should last.
Are nasolabial fold fillers safe?
Nasolabial fold fillers are generally safe when a trained medical provider injects them, and serious adverse events from hyaluronic acid fillers are rare. Redness, swelling, tenderness and bruising usually clear within 7 to 14 days. The most serious risk is filler entering a blood vessel, which can cause tissue death, blindness or stroke; in a review of 98 cases of vision changes from filler, 13.3% involved the nasolabial fold. Seek emergency care for unusual pain, vision changes or white, gray or blue skin after an injection.
What is the difference between nasolabial folds and marionette lines?
Nasolabial folds run from the sides of the nose to the corners of the mouth, while marionette lines run from the corners of the mouth down to the chin. Marionette lines, also called melomental folds, sit below the nasolabial folds and can make you look like you are frowning. Both are linked to aging, sun exposure and smoking, and dermal fillers are a treatment option for both. A clinician can assess both areas at the same visit.
Can a primary care provider treat nasolabial folds?
Yes, a primary care provider can evaluate nasolabial folds, because they are diagnosed by examining the face. At GENEVA in Alpharetta, a provider reviews your folds, goals, medicines and health history, then recommends treatment at GENEVA or a referral to a specialist such as a dermatologist or plastic surgeon. The FDA advises choosing a licensed provider trained in dermal filler injection. Mention any past fillers, bleeding disorders, allergies or blood thinners at your visit.