Nasolabial folds: what forms them, what deepens them, what moves them

The first thing to fix about nasolabial folds is the category. They are filed everywhere as wrinkles, treated as damage, and priced as something to remove. But a nasolabial fold is not a crease worn into skin by use. It is a structural boundary that was there before anything happened to your face — visible in infants, visible in every healthy twenty-year-old, and visible in the people selling its removal. What changes with age is not whether you have one. It is how deep it sits when your face is doing nothing.

That distinction decides everything else, because it sorts the interventions. Things that act on skin surface are aimed at the wrong tissue. Things that act on volume above the fold are aimed at the right one. And the exercises are aimed at a muscle that, if it did what the article promised, would make the fold more prominent rather than less.

What nasolabial folds are, and how they differ from smile lines

Barton and Gyimesi dissected the region and published the anatomy in Plastic and Reconstructive Surgery in 1997. The fold marks the line where muscles of the upper lip — the levator group and zygomaticus — insert into the dermis. Skin that is anchored to muscle sits at a different level from skin that is not, and the resulting step is the fold. Cheek tissue sits on the outer side of that step and lip tissue on the inner side, so the boundary is the seam between two different mechanical territories.

This is why the terminology in the SERP results is a mess and worth straightening out, because the three words are used for three different things.

What causes nasolabial folds to deepen

The modern account of midface ageing is compartmental. Rohrich and Pessa showed in 2007 that facial fat is not one continuous layer but a set of discrete compartments separated by septa, each with its own blood supply — which immediately explains why a face ages unevenly rather than deflating as a whole.

Gierloff and colleagues then measured what happens to those compartments over time. Their 2012 study took computed tomography of cadaver heads in two age bands and quantified the change. Three findings matter here, and all three point at the fold.

• The compartments migrate downward. The distance between the fat compartments and the infraorbital rim was greater in the older group — the midface volume physically sits lower.
• Volume redistributes inside each compartment. The lower third of each compartment grew in sagittal diameter while the upper third shrank, so even without net loss, mass accumulates at the bottom edge.
• Specific compartments lose volume, notably the deep medial cheek fat, which is precisely the support that sits behind the upper portion of the fold.

Put those together and the mechanism is not mysterious. Tissue above the fold sags towards a boundary that is anchored and cannot move with it, and mass piles up on the cheek side of a fixed seam. The step gets taller. Nothing was worn into the skin.

The bone underneath moves too

Mendelson and Wong reviewed skeletal ageing in 2012 and described what happens to the facial skeleton as a scaffold: the maxilla loses projection, the pyriform aperture around the nose widens, and the orbital rim recedes. Soft tissue that was draped over a well-projected structure ends up draped over a less projected one, with the same surface area and less to hold it forward. Fold depth is the visible consequence of a change several millimetres beneath it.

Descent or deflation — the argument that changes the answer

This is where the field is genuinely divided, and it is worth understanding because it determines which interventions make sense. The traditional account is descent: tissue falls, and lifting it is the fix. Lambros challenged that in 2007 with a study comparing photographs of the same individuals decades apart and found that landmarks he expected to have descended had largely stayed put — what changed was volume, not position. Ageing as deflation rather than as gravity.

The current position takes both. Gierloff's imaging supports real inferior migration; Lambros's photographs support real deflation; most faces are showing some of each. It has a practical consequence: a fold driven mainly by lost volume and a fold driven mainly by descended tissue respond to different things, and no article can tell you from a distance which yours is. A clinician looking at your face at rest and in animation can.

How nasolabial fold severity is graded

Trials in this area report their results on the Wrinkle Severity Rating Scale, validated by Day and colleagues in 2004. It is worth knowing because it converts a subjective worry into a category, and because every efficacy number quoted anywhere on the internet is a movement along it.

Do smile lines come from smiling?

The most repeated piece of folk advice in this area — smile less, it is carving lines into your face — has the causation reversed. Smiling contracts exactly the muscles that insert along the fold, so it makes the boundary visible. That is a demonstration of where the anchor points are, not a mechanism for deepening them. If expression were the driver, the deepest folds would belong to the most expressive people, and nobody has shown that.

There is one nuance worth keeping. Repeated contraction does contribute to etched surface lines within a fold over decades, the way it does around the eyes. That is the crease from the terminology table, not the fold, and it is the component that surface treatments can reach. The structure remains a structure.

A face is not damaged by the expressions it makes. The fold marks where your muscles attach, and it was drawn before you had anything to smile about.

Nasolabial folds in your 20s: why they show up early

A substantial share of the people searching this are nowhere near an age where compartment migration explains anything, and the standard ageing article does not answer them. A visible fold at 22 is not early ageing. In a young face the fold is usually about where things attach and how much sits above them.

• Insertion pattern. Where your levator muscles meet the dermis is individual anatomy. A more superficial insertion gives a more defined boundary in a face with no ageing changes at all.
• Full midface volume. More cheek tissue folding over a fixed seam produces a deeper step. This is the case where the fold is a consequence of fullness rather than of loss, and where volume-adding approaches are pointed the wrong way.
• Maxillary projection. A shallower midface skeleton gives less forward support, which shows up decades before any bone resorption. This is skeletal, and it is also why the shape of the lower and middle thirds of your face is worth measuring before assuming a fold is an ageing sign.
• Expressiveness plus thin skin. Produces a crisp line early. This is the profile where the surface-quality interventions — sunscreen, retinoids — are best matched to the actual finding.

The at-rest test separates these from ageing cleanly. Relax your face completely, no smile, mouth closed, and photograph straight on. A young structural fold typically softens almost to nothing at rest; an age-related one persists because the volume above it has moved and stays moved.

What age is it normal to get nasolabial folds?

Every age. The fold is present in infants, so the useful question is not when it appears but how deep it is at rest. The mild grade on the severity scale above — a shallow but visible indentation — describes the ordinary young-adult fold. We did not find a study giving a reliable age-by-age distribution of grades, so no page, including this one, can honestly tell you your fold is early for your age.

Should you treat a fold in your 20s?

Nothing in the research cited here says you need to. The filler studies in this guide enrolled adults with established folds, and none of them tested filler as a way of preventing a young fold from deepening later — so claims that early filler "stops the cascade" are marketing rather than findings. Where the driver is full cheeks, adding volume is pointed the wrong way. The two things with good evidence at this age are the preventive ones further down: daily sunscreen and not smoking.

Nasolabial fold treatments, ranked by what was measured

This is the section that most pages get wrong by listing things in order of popularity. Ordered by evidence quality instead, the picture changes considerably — and two of the strongest entries are preventive rather than corrective.

What the filler meta-analysis actually found

Peng and colleagues pooled 14 randomised controlled trials covering 1,190 patients in 2022, and the question they asked was narrower and more useful than 'does filler work'. They compared monophasic against biphasic hyaluronic acid on WSRS improvement, satisfaction and adverse events. Monophasic came out ahead on fold improvement and on the proportion of satisfied patients, with no significant difference in adverse event rate between the two.

That is a product-selection finding, and it is the level of detail worth carrying into a consultation rather than out of one. This region also sits near the facial artery and its branches, which is why injection here carries a documented vascular risk profile and why the decision is a clinical one. Nothing on this page is a recommendation to have it, and no page can tell you whether it is appropriate for your face.

The two preventive entries deserve their ranking

Hughes and colleagues randomised 903 adults in Queensland to daily or discretionary sunscreen for four and a half years, with blinded assessment of skin microtopography. The daily group showed no detectable increase in skin ageing over the whole period, and 24% less than the discretionary group. It is one of very few randomised trials of anything in cosmetic dermatology, and the intervention costs almost nothing.

Kafi and colleagues ran a randomised, double-blind, vehicle-controlled trial of 0.4% retinol applied three times weekly for 24 weeks, with each participant's other arm as the control. Fine wrinkling improved significantly against vehicle, and biopsies showed increased glycosaminoglycan expression and procollagen I. The endpoint was fine wrinkling on aged skin rather than nasolabial fold depth — so it supports the skin-quality half of the picture, which is the etched line, not the structural step.

Skin quality matters more here than people expect. Fink, Grammer and Matts found that changing skin colour distribution alone shifted ratings of age, health and attractiveness with no change to the underlying geometry at all. A softer-reading fold is partly a lighting-and-surface phenomenon, and surface is the part you can act on cheaply.

Nasolabial fold filler: what trials measured, how long it lasted, and the risk

Filler is the most studied intervention for this fold, which is exactly why it deserves a section that puts the result, the duration and the risk side by side. Nothing here is a recommendation to have it; it is what was measured, so the questions you ask in a consultation can be better ones.

Filling the fold vs supporting the cheek above it

There are two different targets, and the anatomy at the top of this guide explains why. Filling the fold itself puts volume into the step. Supporting the midface above it puts volume where the fat compartments have moved from, so less tissue sits on the cheek side of the seam. A 2025 retrospective study of 51 women aged 30 to 55 who had calcium hydroxylapatite placed over the cheekbone area only, not in the fold, measured the fold six months later: its length shortened by about 13.5% on one side and 6.2% on the other, with severity scores improving too. It had no control group, so it shows that the indirect route moves the fold, not how it compares with filling it directly.

How long nasolabial fold filler lasted in trials

Durations quoted online are usually a range with no source. One of the better-designed trials gives a concrete answer for one hyaluronic acid product: 87 people with severe folds had it injected on one side and bovine collagen on the other, and the folds were graded on a five-point scale every four weeks. At 24 weeks, 96% of the hyaluronic acid-treated folds kept a clinically significant correction, and 81% kept it for a year or more. Repeat treatment needed less than half the volume of the first. Two caveats belong next to those numbers: the trial was run with the manufacturer, and results for one product in severe folds do not transfer automatically to other products or milder folds.

The risks that belong in the same paragraph

The nasolabial region sits over branches of the facial artery, and filler that enters or compresses a vessel can block blood flow. The rarest and most serious outcome is vision loss. A review of every published case up to 2015 found 98 cases of vision changes after filler, and the nasolabial fold was the injection site in 13.3% of them; an update covering 2015 to 2018 found 48 more, 14.6% from the nasolabial fold, with hyaluronic acid responsible for 81% of the newer cases. In both reviews, no treatment reliably restored sight, and most people did not fully recover their vision. The absolute risk is small — these are case reports out of a very large number of injections — but it is the reason this region is a medical procedure and not a beauty treatment.

Hyaluronic acid has one safety property the other fillers lack: an enzyme, hyaluronidase, can dissolve it. Current guidance treats vascular occlusion as an emergency needing immediate high-dose hyaluronidase, and uses lower doses for non-urgent problems such as lumps. Whoever injects should have it on hand and know how to use it, which is a fair thing to ask before anything is injected.

Botox or filler for nasolabial folds?

They act on different tissue, so the question is less which is better than which problem each can reach. Filler adds volume. Botulinum toxin relaxes muscle, or, injected into the skin rather than the muscle, acts on the skin itself — it adds nothing. Since the fold deepens mainly through volume moving, toxin is not a routine treatment for the fold itself.

How to get rid of nasolabial folds without fillers

The honest first sentence: you cannot remove a structure you were born with, with or without filler. What non-injectable options can change is the etched crease within the fold and the skin over it, and — preventively — how fast the fold deepens. In order of evidence, that means daily sunscreen, not smoking, and a retinoid, with everything else a long way behind.

Face yoga for nasolabial folds: the muscle-volume claim

The usual claim is that exercising the cheek muscles builds them up so they fill out the fold. There are two problems with it. No controlled trial has measured fold depth after facial exercise; the systematic review found no randomised trials at all, and the best pilot study rated cheek fullness, not the fold. And the fold forms where muscles of the upper lip pull on the skin, so more muscle bulk on the cheek side of that seam is not obviously the direction you want. The facial exercise guide covers the exercise evidence in more detail.

Thread lifts, and why they come up in Korean clinics

Threads placed under the skin to reposition tissue are a common answer to the question of what Koreans do for nasolabial folds, and some of the most detailed recent writing on them comes from Korean anatomists. A 2024 review from Yonsei University classifies nasolabial folds into three types by cause and describes thread techniques for each, with attention to the arteries that make the area risky. It is a technique guide rather than an outcome trial, which matches the treatment table above: threads are an active area, and long-term comparative data are still thin.

Creams and serums: retinoids, vitamin C, peptides

Retinoids are the only topical group with solid evidence of changing the skin itself. In the classic tretinoin study, photodamaged skin made 56% less new collagen than sun-protected skin, and ten to twelve months of prescription tretinoin raised collagen formation by 80% while the placebo cream group fell by 14%. The retinol trial earlier in this guide found the same direction with an over-the-counter strength. Both measured arm skin, not the fold, so they support softening the crease component rather than the step. We did not find a controlled trial showing vitamin C serums or peptide creams changing nasolabial fold depth, and a cream cannot reach the volume beneath the fold.

How to prevent nasolabial folds from deepening

Four, in the order the evidence supports rather than the order they are usually listed.

1. 1Daily broad-spectrum sunscreen. The randomised trial above is the strongest result in this entire subject, and it is preventive — it does nothing for a fold that already exists, and a great deal for the one you would otherwise have in ten years.
2. 2Not smoking. Okada and colleagues photographed 79 pairs of identical twins where one smoked or had smoked at least five years longer, and had three blinded judges grade them. The smoking twins scored worse on nasolabial folds specifically, alongside lower lid bags, malar bags, upper lip wrinkles and jowls, with effects concentrated in the middle and lower thirds of the face. Genetics held constant, five years of difference was visible.
3. 3Weight stability. Repeated substantial gain and loss stretches and empties the same compartments Gierloff measured. There is no trial isolating this against fold depth, so it sits below the two above on evidence and above them on how often it is ignored.
4. 4Sleep position. Anson, Kane and Lambros described the mechanism in 2016 — hours of nightly compression and shear against a pillow — and the twin study found prone sleepers had measurably more facial asymmetry. Neither measured this fold as an endpoint. If you are wondering how to get rid of nasolabial folds while sleeping, sleeping on your back removes one source of compression — a variable, not a treatment. Worth changing if you can; not the lever people hope it is.

Why nasolabial folds look deeper in photos

More people are alarmed by a photograph than by a mirror, and the reason is usually the light. This region is read almost entirely as a shadow, which means the light source has more control over its apparent depth than the tissue does.

There is one genuine limit on top of that. This fold is partly a depth feature, and a single front-on photograph contains no depth information at all — the projection of the maxilla behind it is invisible head-on. It is the same limitation that means four of the seven nose types cannot be settled from a front photo either. A three-quarter view carries more of what matters here than a straight-on one does.

Seeing a nasolabial fold change before deciding on one

If you are far enough along to be weighing an actual procedure, the useful thing is not another article. It is seeing the change on your own face rather than on a stock before-and-after belonging to someone with different anatomy.

The midface volume simulation renders one change on your own photograph so you can look at the result rather than imagine it. Two things about that render are worth stating plainly, because they are the reason it is useful at all: it is an AI simulation and not a surgical or clinical outcome, and every frame on this site says so. It is something to take into a consultation as a way of describing what you want, not a substitute for having one, and not a prediction of what any clinician would achieve.

And the last thing, which the anatomy has been saying throughout: this page is a description of published research, not medical advice, and no measurement or image on this site is a diagnosis. Whether anything here applies to your face is a question for a qualified clinician who is looking at it.