What Causes Nasolabial Folds

Nasolabial folds are not simply wrinkles. They are the visible boundary between the cheek and the upper lip, and they deepen through a combination of repeated muscle activity, collagen loss and the redistribution of facial fat. Which of these predominates determines what treatment is appropriate.

What they are

Nasolabial folds are the lines running from the sides of the nose to the corners of the mouth. They are a normal feature of facial anatomy and deepen with age.

The primary contributor is repeated use of specific facial muscles — those engaged in smiling and frowning. Over time these habitual expressions produce deeper creases. Changes in skin elasticity from reduced collagen and elastin, and changes in the distribution of subcutaneous fat around the cheeks, contribute significantly.

The anatomy

Facial structure

The face is layered. The epidermis is the outer barrier layer. Beneath it the dermis contains collagen and elastin, which determine skin firmness and elasticity. Deeper still, subcutaneous tissue containing fat provides volume and contour.

Beneath the skin, a network of muscles produces facial expression. The zygomaticus major elevates the corner of the mouth in a smile; deeper muscles such as the buccinator act on the cheek during chewing and speech.

How the fold forms

Nasolabial folds result from habitual facial movement combined with age-related change. Each expression pulls on the underlying muscle, and over time temporary creases become established.

Ageing reduces skin elasticity through decreased collagen and elastin production in the dermis. The skin no longer returns to its previous position after an expression as readily as it once did.

Ageing also changes how fat is distributed in the subcutaneous layers. Loss of volume around the cheeks accentuates the nasolabial fold, because the tissue above it descends without the support previously provided by the fat pads beneath.

That last point matters clinically. Where the fold has deepened because of mid-face volume loss, filling the fold directly treats the symptom rather than the cause, and produces a heavier result than restoring volume in the cheek.

What accelerates them

Individual anatomy

Inherited skin characteristics — thickness, elasticity, collagen quality — can predispose to more pronounced folds from an earlier age. A family pattern of prominent nasolabial folds is a reasonable predictor.

Lifestyle

Smoking Smoking accelerates collagen loss and impairs blood flow to the skin, producing deeper folds sooner.

Sun exposure Frequent sun exposure accelerates degradation of collagen and elastin. Daily broad-spectrum sunscreen protects these proteins.

Weight change

Weight fluctuation affects facial structure. Increased subcutaneous fat may initially obscure the folds; weight loss reduces facial volume and accentuates them by leaving lax skin without underlying support.

Facial expression

Regular expression leaves its mark. Smiling and frowning gradually establish grooves through continuous muscle activity.

Prevention

General health

Diet, sleep and stress affect skin health. Increasing antioxidant intake through fruit and vegetables counters free radicals that degrade collagen and elastin.

Sun protection

Ultraviolet radiation breaks down collagen, contributing to laxity and more pronounced folds. Daily sunscreen of at least SPF 30 — including in winter and on overcast days — is the single most effective preventive measure.

Hydration

Hydrated skin maintains elasticity better. Topical moisturisers preserve surface moisture; adequate water intake supports the skin from within.

Treatment options

Hyaluronic acid fillers

Composed primarily of hyaluronic acid, these restore volume and soften the fold. Application takes under an hour with limited recovery time, and the result is visible immediately. They are reversible, which is a meaningful advantage.

Laser therapy

Laser treatment penetrates the skin layers and stimulates collagen production, which supports firmness and elasticity. The reduction in the appearance of the folds is gradual, developing over time as the skin’s texture and firmness improve.

Chemical peels

A chemical solution removes older skin layers, revealing skin beneath. Available in varying depths, peels address surface texture and tone alongside the folds.

Facelift surgery

For deeper folds associated with significant tissue descent, surgery addresses the underlying structures rather than the crease itself. Where the cause is descent rather than volume loss, this is the treatment that addresses the cause.

Which is appropriate

The treatment depends on the depth and cause of the fold. A fold caused by mid-face volume loss calls for volume restoration; one caused by tissue descent calls for a lifting procedure; one caused primarily by surface skin change calls for resurfacing. Assessment establishes which of these applies before anything is recommended.