Nasolabial folds

Nasolabial folds are the creases that run from the side of the nose to the corners of the mouth on both sides of the face. They are a normal anatomical feature —everyone has them, even children when they smile— but they deepen and become more visible over the years, making them one of the most common reasons for an aesthetic consultation.

Why they deepen

The fold marks the boundary between the cheek and the upper lip. It deepens through a combination of factors:

• Volume loss in the midface: with age, the fat in the cheeks decreases and descends. The cheek “falls” towards the fold and makes it more prominent.
• Sagging: the skin loses collagen and elastin, and the ligaments that hold the tissues in place relax.
• Bone changes: the upper jaw bone also loses volume over time, reducing support for the face.
• Other factors: genetics, sun exposure, smoking and significant weight loss speed up the process.

Grades

In consultation the folds are usually assessed with visual scales ranging from mild (barely visible at rest) to moderate (visible with the face relaxed) and severe (deep fold, often with sagging cheeks and marionette lines). The grade guides treatment.

Treatment

The key is to treat the cause, not just the fold. Simply filling the crease, especially when the cause is volume loss in the cheek, can look heavy and unnatural.

• Hyaluronic acid: the most widely used filler for this area. Depending on the case, it is injected directly into the fold, into the cheek to restore midface support, or both. Clinical trials support its effectiveness for nasolabial folds. The result is immediate and reversible.
• Facial biostimulation: biostimulators trigger collagen production and progressively improve firmness. They are useful when mild to moderate sagging predominates.
• Face lift: when the cheek has descended significantly, the most effective treatment is to reposition the tissues surgically. A deep plane face lift acts directly on the cheek descent that deepens the fold.

Prevention

The fold itself cannot be avoided, but its deepening can be delayed: sun protection, not smoking, keeping a stable weight and looking after skin quality with hydration and biostimulation treatments from the age of 35-40.