Deep Nasolabial Folds: Causes and Treatment Options

What are nasolabial folds?

Nasolabial folds are the lines that run from the sides of the nose down to the corners of the mouth. Everyone has them; they are part of how the face moves when we speak and smile. Children and young adults have them too, visible mainly with expression. With time, the folds become deeper and remain visible at rest, and the area beside them may look heavier.

Patients often describe these lines as making them look tired, older or unhappy, and notice them particularly in photographs or overhead lighting. It is natural to focus on the line itself. But the fold is usually the visible edge of changes happening in the cheek above it, and treating the line alone can sometimes make the face look heavier.

The anatomy behind the fold

The nasolabial fold marks the boundary between the cheek and the upper lip. On the cheek side lies the malar fat pad, a cushion of fat that in youth sits high on the cheekbone. On the lip side, the skin is more firmly attached to the underlying muscles that lift the lip. The fold forms where these two zones meet.

With age, the retaining ligaments that hold the cheek fat in place loosen, and the SMAS, the supportive layer beneath the skin, relaxes. The malar fat pad slides downward and forward until it rests against the fold, deepening it. At the same time, the bone of the upper jaw near the nose gradually recedes, removing support from beneath, and the skin loses collagen and elasticity. Expression muscles, used thousands of times a day, reinforce the crease. The deep fold is therefore the result of descent from above, loss of support from below and changing skin.

How nasolabial folds are assessed

Dr. Kim Jun-young, representative surgeon, examines the fold at rest and in expression, from the front and the side. He observes the position and fullness of the cheeks, the depth of the groove beside the nose, skin quality and the relationship with jowls and marionette lines below. He gently lifts the cheek upward and outward: if the fold softens considerably, cheek descent is the dominant cause.

He also asks about previous filler treatments. Repeated filling of the fold, especially in large amounts, can sometimes add weight to the area and create a heavier look. Understanding what has been done before helps him plan a more balanced approach. In some cases, allowing earlier filler to dissolve or settle before adding anything new gives a clearer picture of the underlying anatomy.

Finally, he considers your smile. Some folds deepen dramatically with expression because of strong lip-elevating muscles, and these behave differently from folds created mainly by descent. Recognizing the difference helps set realistic expectations from the start.

Treatment options for nasolabial folds at Will Be

Listed from least to most invasive:

Skin quality treatments

Collagen stimulators such as Juvelook may gradually improve skin firmness, softening fine lines around the fold.

Dermal filler

Dermal filler placed deeply near the base of the nose can restore support and soften the fold, with immediate results. Conservative amounts avoid a heavy look.

PRP micro fat grafting

PRP micro fat grafting uses your own fat, sometimes placed both beside the fold and in the upper cheek, to restore volume where it has been lost. Some fat is absorbed, and a second session is occasionally considered.

Thread lift

A thread lift can lift mildly descended cheek tissue, softening the fold with modest downtime. Its effect is temporary.

Mini facelift or facelift

When cheek descent is significant, a mini facelift or full facelift repositions the SMAS and cheek tissues, softening the fold as part of a broader lift.

How to choose between filling and lifting

If your cheeks are well positioned and the fold is mainly a groove, adding volume with filler or fat is logical. If the cheeks have clearly descended and lifting them softens the fold, a lift addresses the cause. In many patients, a combination works well: a lift to restore position and a little volume to replace what was lost.

Our comparison of filler and fat grafting explains the differences between those two options. Dr. Kim will explain what each approach can realistically achieve for your face, and how the fold will look when you smile, which matters as much as how it looks at rest. Where downtime is limited, a staged plan starting with injectables and reassessing later is also a reasonable path.

A fold is part of a natural face

It is worth saying that the nasolabial fold should never be erased completely. A face without any fold looks unnatural, especially in expression. The aim is to soften a deep fold so that it no longer dominates, not to flatten the area.

At Will Be, Dr. Kim considers the midface as a whole, including the cheeks, the eyes and the jawline. Addressing the fold in isolation can create imbalance; addressing it in context tends to produce a result that looks naturally rested. You will be you, with a softer, lighter expression.

What realistic improvement looks like

For most patients, successful treatment means a softer, shallower fold at rest, a fresher midface and a less tired expression, while retaining natural movement when smiling. The degree of change depends on the method and your anatomy.

After filler, swelling usually settles within a few days. After fat grafting, swelling may last one to two weeks, with the result stabilizing over about three months. After a facelift, visible swelling typically settles over two to three weeks, with refinement over several months. Risks include bruising, lumps, asymmetry, partial fat absorption, and with surgery, scarring and temporary numbness. Individual results vary.