What is a Nasolabial Fold?

Smile lines, or nasolabial folds or laughter lines, are two deep wrinkles or lines which run from each side of the nose down to the corners of the mouth. Smile lines are a natural facial feature that are commonly associated with facial expressions, such as smiling and laughing, and comprise a normal anatomical facial feature.  

Smile lines are very common and tend to become more obvious with age as skin laxity increases in the lower face. Smile lines vary in severity from person to person, with several lifestyle factors such as sun exposure and smoking particularly associated with deepening smile lines. Losing or gaining a lot of weight can also cause them to worsen.  

Many people are bothered by the development of laughter lines and decide to have treatment to make their nasolabial folds look less prominent. In this article, we will explore some of the most popular options, with a particular emphasis on dermal fillers and surgical face lifts. 

Smile lines are caused by changes to the skin, fat and connective tissues in and around the mouth area that typically develop with age as the skin loses its elasticity and collagen. Losing these makes the skin thinner and more prone to forming wrinkles and lines all over the face, including the mouth area. 

Other key factors that cause smile lines are genetic predisposition toward developing laugh lines and exposure to several key lifestyle factors that impact this region of the face. Prolonged exposure to UV rays of the sun accelerates ageing by catalysing the breakdown of collagen and elastin, as do the chemicals in tobacco smoke, leading to the premature development of smile lines.  

Loss of facial fat in the cheek area results in a loss of volume and support for sagging skin and the increase of creases and folds in the nasolabial area. This can be exacerbated by rapid weight loss or gain, making the condition worse. 

As hinted in the name, smile lines are also closely linked to facial expressions and the repetitive contraction of the facial muscles around the mouth. The muscles around the mouth, mainly the orbicularis oris, zygomaticus major, and levator labii superioris, are all involved in facial expressions like smiling and speaking. Over time, the repetitive stress on these muscles, in combination with increased skin laxity and loss of fat, causes smile or laugh lines to form. 

It's essential to understand that the precise relationship between all of these causal factors and the formation of laugh lines is not fully known and varies from person to person. One can maintain a balanced and healthy lifestyle, including other elements known to promote good skin health, such as proper hydration, a nutritious diet, and diligent skincare practices, yet still develop smile lines simply with the onset of age.  

As such, many people turn toward cosmetic smile line treatments to eliminate their smile lines and get rid of them permanently. 

Getting rid of smile lines fast is a challenging task, because these lines are typically a natural part of facial expression and aging.  

For fast, significant and lasting changes for getting rid of smile lines surgical procedures typically represent the best treatment option. 

There are 4 main surgeries employed to get rid of smile lines: 

• Mini Face Lift or Facelift: these procedures aim to rejuvenate the whole facial area, including laugh lines and nasolabial folds. Excess skin is removed, underlying muscles tightened and tissues repositioned to deliver a rejuvenated, fresh appearance. In this process the skin around the mouth area can effectively be tightened and nasolabial fold creases eliminated. Long lasting results, and considered one of the best treatments for smile lines.  
• Fat Transfer to Face (Fat Grafting): this procedure involves harvesting fat from one part of the body where the patient has excess fat deposits (e.g. thigh, buttock, stomach) via liposuction, and then transferring it to the face via an injection. Fat is injected into areas with volume loss, including the nasolabial folds, to restore fullness and smooth out wrinkles. Long lasting results, low pain profile and also considered one of the best treatments for smile lines, and a good alternative to dermal fillers. You can see some before and after examples here. 
• Cheek Implants: facial implants can add volume to the mid-face, reducing the depth of nasolabial folds and remove smile lines, restoring more youthful contours to the face.  
• Buccal Fat Pad Removal:  if excess buccal fat pads in the lower cheeks are contributing to the formation of laugh lines, then removing them can help create a slimmer facial contour and eliminate smile lines. 

As with any elective cosmetic surgery, these invasive procedures require sedation and meaningful downtime. For those looking for something quicker, effective and with less downtime non surgical alternatives may be preferred.

Dermal fillers (“Laugh line fillers”) are quick, injectable treatments which are very popular with those seeking a swift, non-surgical solution for ageing skin and looking to remove smile lines. The active ingredient, hyaluronic acid, is naturally found in the skin, tendons and muscles of humans and, therefore, naturally combats an array of natural ageing symptoms. 

Dermal fillers for smile lines are a popular ‘gateway’ treatment to remove smile lines as they are not permanent and are not as invasive an option as surgery. Upfront costs are also lower than more invasive options such as face lifts and fat transfer. Dermal fillers are, therefore, an intuitive first step on the journey to remove smile lines. 

There are many different types of temporary dermal fillers for smile lines. At the Cadogan Clinic, we only use Juvederm and Restylane, two industry leading filler products with millions of users worldwide. 

At the Cadogan Clinic, we only use temporary or 'resorbable' fillers based on naturally occurring hyaluronic acid that dissolves over time, as these are the safest and lower the risk of any long term side effects. 

Dermal fillers for smile lines can be applied in just 10 to 15 minutes. There is no need for an anaesthetic, and those who have laugh line fillers can immediately return to work or their daily routine. No recovery time is needed following dermal filler smile line treatment. 

Some people believe that facial exercises can get rid of nasolabial folds. You should treat such claims with caution, and pursue medical advice and medical treatment if you want to have any real effect on the appearance of these stubborn folds.