Smile Lines: Nasolabial Folds Treatment

Nasolabial folds treatment starts with the cheek above the fold, not the line itself. Where cheek deflation drives the fold, support is restored at the mid-face; where descent drives it, lifting such as VF Lift – Vertical Facelift is considered; conservative, deep filler at the fold comes last. Skin-quality treatment improves how the crease reflects light.

In brief

The nasolabial fold is a structural crease where the mobile cheek meets the fixed upper lip; every face has it.
It deepens with age as cheek fat compartments deflate and descend and tissue piles against the fold from above.
Assessment starts with the cheek above the fold; the line itself is treated conservatively and last.

Key takeaways

The nasolabial fold is a structural crease where mobile cheek meets the fixed upper lip; every face has it.
It deepens with age as cheek fat compartments deflate and descend and tissue piles against the fold from above.
Assessment starts with the cheek above the fold; the line itself is treated conservatively and last.
Filling only the line, face yoga and smile line creams do not address the cause.
Dr Sin Yong, an aesthetic physician, assesses the mid-face personally; treatment is elective.

On this page

Key Facts
What do nasolabial folds look like?
Why does the nasolabial fold deepen with age?
Why filling the line itself is often the wrong move
What actually works for nasolabial folds?
What doesn't work for nasolabial folds?
Dr Sin Yong’s Viewpoint
Which type do you have?
What does not work, and why
When to see a doctor
Myths we hear in clinic
Questions Patients Actually Ask
Why do some people have deep nasolabial folds when they are young?
Nasolabial folds, marionette lines and smile lines — what is the difference?
When is a nasolabial fold beyond non-surgical treatment?
How do you get rid of smile lines?

An East Asian woman in her mid 40s smiling softly — illustrative image — Illustrative image — not a patient.

Key Facts

What it is: The junction where mobile cheek tissue folds against the fixed upper lip — a structural crease, not a wrinkle
Why it deepens: Cheek fat compartments deflate and descend with age, piling tissue against the fold from above
The at-rest threshold: Visible in animation is normal at any age; carved-in at rest is the ageing change
The classic error: Volume injected into the fold itself — adding bulk where tissue is already piling up
The evidence: Meta-analysis of randomised trials supports HA filler for fold correction — technique and placement drive results
The overfill risk: A heavy, flattened mid-face — the pattern covered in the pillow face guide
Who assesses this: An aesthetic physician — reading the cheek above before the fold itself
Typical first step: Mid-face assessment; the fold is treated cause-first, not line-first

What do nasolabial folds look like?

The nasolabial fold (circled) — the crease from nose to mouth corner that deepens with age. Image: Mikael Häggström, from original by Sue Campbell/U.S. Air Force, via Wikimedia Commons (Public domain).

Nasolabial folds seen from the front and in profile. Image: Patin E et al., International journal of women's dermatology (2026), via PubMed Central (CC BY).

Why does the nasolabial fold deepen with age?

Every face has this fold — it is where the mobile cheek meets the fixed upper lip, and it creases every time you smile. What changes with age is the traffic arriving from above: the cheek's fat compartments — discrete, named structures in the anatomical literature [2] — deflate and slide downward, and the descending tissue piles up against the fold like snow against a fence. The fold does not so much deepen as become the collection point for everything the mid-face is losing. That is why it appears alongside cheek volume loss and early jowling — three symptoms of one descent.

Why filling the line itself is often the wrong move

The intuitive treatment — inject the crease — treats the shadow and ignores the object. Meta-analytic evidence supports hyaluronic-acid fillers for nasolabial fold correction [1], but modern technique reads that evidence anatomically: restoring the deflated cheek above often softens the fold more naturally than loading the fold itself, because it removes the tissue traffic rather than padding the collection point. Direct fold treatment still has a role — conservative, deep, and structural — but as the finishing move, not the opening one. Overfilled folds and cheeks are precisely how faces end up in pillow face territory, and unpicking that costs more than doing it right once.

What actually works for nasolabial folds?

Assessment starts above the fold: how much is cheek deflation (restore support at the cheek and mid-face), how much is descent (the lifting conversation — VF Lift, HIFU-class energy), and how much is the fold's own etching (conservative structural filler at the fold, supported by the trial literature [1]). Skin-quality work — bio-remodelling, polynucleotides — improves how the crease reflects light. Most faces need the sequence, not a syringe in the line.

What doesn't work for nasolabial folds?

Face yoga against a structural fold — the crease is anatomy, not weakness. 'Smile line' creams — no topical reaches the fold's depth. Aggressive filling of the fold alone — the classic route to a heavy, simian mid-face that reads worse than the line did. And treating the fold while ignoring the deflating cheek above it — the traffic keeps arriving, and so do the appointments.

“The nasolabial fold is usually the shadow of the cheek above it — fill the shadow and you've padded the collection point while the descent continues.”
— Dr Sin Yong

Dr Sin Yong’s Viewpoint

The nasolabial fold is where I most often decline the treatment a patient arrives asking for. Filling the line is intuitive, quick to sell, and frequently wrong — the fold is usually collecting what the cheek above is losing. I treat the cause first, the crease last, and conservatively. It takes longer to explain than to inject, which is exactly why the explanation matters.

Prefer Not to Use WhatsApp?

Use the short enquiry form instead →

Leave your name, mobile number and email and the clinic will contact you directly. No obligation.

Thank you — your enquiry has been received. The clinic will contact you during opening hours (Mon–Fri 10am–8pm, Sat 11am–3pm).

Or continue on WhatsApp instead →

Prefer a preliminary view first? You can also WhatsApp a photo of the area for Dr Sin Yong to review before you decide on a visit.

Types of nasolabial fold and look-alikes: how each is recognised and what it needs
Type / look-alike	How to recognise it	What it needs	What does not work
Cheek-deflation fold	Emptied mid-cheek above a deepening fold, often after weight loss	Support restored at the cheek and mid-face	Filling only the line itself
Descent-driven fold	Cheek tissue sits lower and piles against the fold	Lifting, such as VF Lift – Vertical Facelift, where indicated	Adding filler, which adds weight in the wrong place
Fold etched at rest	Crease visible at rest, not only when smiling	Conservative, deep structural filler at the fold, as a finishing step	Overfilling, which flattens the cheek-to-lip transition
Fold with surface quality change	Fine lines and a crease that reflects light unevenly	Skin-quality treatment such as bio-remodelling or polynucleotides	Smile line creams, which do not reach the fold's depth
Marionette lines (look-alike)	Lines running down from the mouth corners, separate from the fold	Separate assessment of lower-face support	Treating them as the same fold

Questions Patients Actually Ask

Are nasolabial folds normal?+

Completely — every face makes them in animation at every age. The ageing change is when they carve in at rest. Treatment is elective aesthetics, never necessity.

Why did mine deepen after losing weight?+

Facial fat loss deflates the cheek compartments, and the deflating tissue settles against the fold. Significant weight loss commonly deepens nasolabial folds even as the body improves.

Is filler in the nasolabial fold safe?+

In experienced hands, with conservative technique, the trial evidence supports it — though this area contains the facial artery's path, which is exactly why anatomy-led injection matters here.

Why do some filled nasolabial folds look strange?+

Overfilled folds flatten the natural transition between cheek and lip, producing the heavy 'monkey mouth' look. Restraint and treating the cause above the fold is the difference.

Can HIFU or lifting treatments soften nasolabial folds?+

When descent is the driver, repositioning cheek tissue reduces what piles against the fold — often more naturally than any filler in the line.

Will the fold come back after treatment?+

The ageing process continues, so maintenance applies to every approach. Sequenced cause-first treatment tends to hold its result more gracefully than fold-stuffing.

At what age do nasolabial folds start to show at rest?+

There is no fixed age. The fold is present in animation at every age, and when it begins to stay visible at rest depends on bone structure, cheek fullness, weight changes and sun exposure more than on the calendar.

Can nasolabial folds be improved without filler?+

Sometimes. Where descent and laxity are the driver, energy-based lifting such as VF Lift – Vertical Facelift or focused ultrasound works on the tissue that piles against the fold, and skin-quality treatment improves how the crease reflects light. Where cheek volume loss is the driver, those approaches cannot replace the missing volume.

Is hyaluronic acid filler in the nasolabial area reversible?+

Hyaluronic acid filler can be dissolved with hyaluronidase if required, which is one reason it is preferred in this area. Collagen-stimulating fillers do not dissolve in the same way, which makes conservative planning more important when they are considered.

How is a nasolabial fold assessed at consultation?+

The fold is examined at rest and in animation, from the front and in profile, together with the cheek above it, the jawline below and the quality of the skin. Previous filler or threads are noted, because earlier product changes the plan. Only then is the balance of deflation, descent and etching decided.

Can a thread lift help smile lines?+

Where the fold is fed by a cheek that has descended, cog threads placed from a temporal anchor across the cheek reposition the malar fat pad. Threads add no volume, so where the fold is driven by volume loss they do not resolve it on their own, and filler is assessed separately.

What causes nasolabial folds?+

The fold is where mobile cheek meets the fixed upper lip, so it creases with every smile. With age, cheek fat compartments deflate and slide downward, and the descending tissue piles against the fold. Bone structure, cheek fullness, weight changes and sun exposure influence when it stays visible at rest.

Can nasolabial folds be fully removed?+

No, because the fold is normal anatomy present in every face. Treatment addresses what deepens it, such as cheek deflation or descent, and softens how pronounced it looks at rest. Ageing continues, so maintenance applies to every approach, and an assessment decides whether treatment is advised.

Which treatment suits nasolabial folds?+

It depends on what drives the fold. Cheek deflation suits restoring support at the mid-face, descent suits lifting, and an etched fold may suit conservative deep filler as a finishing step. Skin-quality treatment improves how the crease reflects light. Most faces need a sequence rather than a single injection.

How much does nasolabial fold treatment cost in Singapore?+

The fee depends on whether the cheek, the descent or the fold itself is treated, the product or device used, the areas involved, and whether treatments are combined in sequence. A written quote is given at consultation after mid-face assessment, and the assessment decides whether treatment is advised at all.

Why do some people have deep nasolabial folds when they are young?

Deep nasolabial folds at a young age usually reflect anatomy rather than ageing. The fold forms where the mobile cheek meets the fixed upper lip, so anything that makes the cheek fuller or the support beneath it flatter deepens the crease — even in someone in their twenties with no laxity at all.

The common contributors are structural. A flatter mid-face skeleton, with less forward projection of the upper jaw beside the nose, gives the cheek less to rest on. A full medial cheek fat pad adds weight on the cheek side of the fold. Strong upper-lip elevator muscles crease the fold deeply with every smile, and habitual expression repeats that crease many times a day.

Weight changes play a part too: rapid loss deflates the cheek, while weight gain adds bulk that folds more heavily. Sun exposure and smoking matter more later, through skin quality. The practical consequence is that a young, deep fold is rarely a reason for filler in the line. It calls for reading the cheek and skeleton first — and sometimes for no treatment, because a fold that only shows in animation is normal.

Nasolabial folds, marionette lines and smile lines — what is the difference?

Smile lines and laugh lines are everyday names for the nasolabial folds; marionette lines are a separate crease. The nasolabial fold runs from each nostril to the corner of the mouth. Marionette lines run downward from the corners of the mouth toward the jawline and chin, and they belong to the lower face rather than the mid-face.

The distinction matters because the causes differ. The nasolabial fold is fed by deflation and descent of the cheek above it. Marionette lines are shaped by changes around the jawline and chin — loss of support, descent of tissue toward the jowl, and the pull of the muscle that draws the mouth corners down. A face can show one without the other, and treating the wrong one leaves the visible problem in place.

Vertical lines on the upper lip are a third, unrelated group: fine etched lines from lip movement and skin quality, treated very differently again. In consultation, the first task is to name which lines are present and which one is actually bothering you, because a plan for the fold does little for the mouth corners, and the reverse.

When is a nasolabial fold beyond non-surgical treatment?

A nasolabial fold is beyond non-surgical treatment when the descent and loose skin behind it are greater than restoring volume or tightening can address. The signs are usually visible together: heavy tissue hanging over the fold, established jowls, a loose neck and skin that gathers rather than springs back when gently lifted.

In that situation, adding more filler is the route to a heavy, overfilled mid-face, and energy-based lifting may soften but not reposition the tissue. A surgical facelift or mid-face lift repositions descended tissue and removes excess skin, which is something no injectable or device does. Patients in that category are told so plainly and referred to a plastic surgery specialist for assessment.

Surgery is not the end of the conversation. A lift repositions tissue but does not restore the volume the cheek has lost, nor improve skin quality, so conservative volume and skin treatment may still have a role afterwards. The point of assessment is to match the treatment to the stage of the face, rather than stretching one approach beyond what it can do.

Nasolabial fold treatment options compared by cause
Option	What it does	What it cannot do	Typical recovery	Who it tends to suit
Cheek and mid-face support with hyaluronic acid filler	Restores deflated cheek fat compartments above the fold, reducing the tissue that piles against it	Reposition heavy descent or erase a fold that has etched into the skin	Possible swelling and bruising that settle; hyaluronic acid can be dissolved with hyaluronidase if required	A fold driven mainly by cheek volume loss
Conservative, deep filler at the fold	Softens the fold's own etching as a finishing step	Address the deflation and descent above that feed the fold; overfilling flattens the cheek-lip transition	Possible swelling and bruising that settle; reversible with hyaluronidase if hyaluronic acid is used	An etched crease that remains once the cause above has been addressed
VF Lift – Vertical Facelift (Volnewmer monopolar radiofrequency)	Heats the deeper skin to work on laxity and the descent that loads the fold	Replace lost volume or fill an etched line	Varies between patients; discussed at consultation	Descent with skin laxity, where volume is reasonably preserved
HIFU (focused ultrasound)	Delivers focused ultrasound energy to deeper tissue layers to address descent	Replace lost volume or treat skin quality	Varies between patients; discussed at consultation	Descent-led folds in a face that does not need volume
Skin-quality treatment (bio-remodelling, polynucleotides)	Improves skin quality so the crease reflects light more evenly	Change the structure beneath the fold or fill it	Small raised injection points that settle	Thin or crepey skin over a moderate fold
Facelift surgery — referred to a plastic surgery specialist	Surgically repositions descended mid-face and lower-face tissue and removes excess skin	Restore lost volume on its own or change skin quality	Surgical recovery, guided by the operating team	Advanced descent and skin excess beyond the reach of non-surgical treatment

Medically reviewed by Dr Sin Yong, MBBS (NUS), MRCS (Edinburgh) · Last updated 5 October 2026 · Editorial policy

How do you get rid of smile lines?

Smile lines cannot be erased entirely, because the nasolabial fold is normal anatomy that forms every time you smile; what treatment can change is how deeply it sits at rest. Getting rid of a deepened fold starts with finding out what is feeding it, not with treating the line itself.

Three causes are separated at assessment. Where the cheek above has deflated, support is restored at the mid-face and the fold is reassessed before anything is placed in it. Where tissue has descended, lifting is the conversation: radiofrequency such as VF Lift – Vertical Facelift, focused ultrasound, or a thread lift for a defined descent. Where the crease has etched into the skin, conservative, deep filler at the fold is the finishing step, and skin-quality treatment improves how the crease reflects light.

Creams, face yoga and gadgets do not reach the structures involved. Sun protection and avoiding large swings in weight address two of the things that deepen the fold over time, and where descent and loose skin are advanced, referral to a plastic surgery specialist is the honest answer.

Smile lines: filler vs thread lift vs energy device
Approach	What it addresses in smile lines	Limits	Where it fits
Hyaluronic acid filler, cheek first	Restores deflated cheek support above the fold; conservative, deep filler at the fold softens remaining etching	Does not reposition heavy descent; overfilling flattens the cheek-to-lip transition	Volume-led folds, with the fold itself treated last, if at all
Thread lift (Bliss Lift, PDO and PCL cog threads)	Repositions a descended malar fat pad along vectors from a temporal anchor across the cheek	Adds no volume and removes no skin; a fold driven by volume loss is not resolved by threads alone	Descent-led folds with skin that still has elasticity
Radiofrequency (VF Lift – Vertical Facelift, Volnewmer monopolar RF)	Heats the dermis and subcutis along vertical vectors to work on the laxity that loads the fold	Cannot replace lost volume or fill an etched line	Laxity where volume is reasonably preserved
Focused ultrasound (HIFU)	Places thermal coagulation points in deeper layers to work on descent	Cannot replace volume; used with caution in thin faces because of the risk of fat loss	Descent-led folds in a face that does not need volume