Everybody has nasolabial folds. They are the creases where the cheek meets the upper lip, running down on either side of the mouth, and they are present in a six-month-old baby just as they are in a sixty-year-old. Without them, smiling would be difficult.
What changes over time is how deep they are when the face is at rest. That shift is what brings people to a consultation, usually with a photograph from a few years earlier and a question about what happened in between.
Why do nasolabial folds get deeper?
Mostly because of what is happening above them rather than in the fold itself. The cheek carries several distinct pads of fat, and with age those pads lose volume and shift downwards. The tissue that used to sit high on the cheekbone gathers lower down, and it comes to rest against the fold, deepening the crease from above.
Three other things compound it. Collagen and elastin decline, so the skin holds its position less well. The bone underneath the cheek and around the eye socket gradually remodels and gives less support than it did. And gravity does what gravity does, over decades.
What speeds it up
- Sun exposure, which breaks down collagen faster than anything else in normal daily life
- Smoking, through both collagen damage and the repeated pursing movement
- Significant weight loss, which can empty the cheek quickly enough that skin has no time to adapt
- Sleeping consistently on one side, which some people notice as a deeper fold on that side
- Genetics, which decide the shape of your cheekbone and where your fat pads sit to begin with
Why treating the fold itself often disappoints
This is the part worth understanding before spending money on anything. If the cheek has descended and the fold is the place where that tissue has come to rest, then filling the crease treats the symptom while leaving the cause where it is. The line looks better in the mirror for a while, and the face can end up heavier around the mouth without looking any younger.
An experienced practitioner will usually spend more of the consultation looking at your midface than at the fold you came in about. Restoring support higher on the cheek frequently softens the fold as a consequence, and it does so without adding weight to the lower face.
Energy-based treatments: working on the skin and its support
These aim at collagen and at laxity, rather than at replacing lost volume. They tend to suit earlier changes, mild to moderate folds, and people who would rather not start with injectables.
Radiofrequency microneedling
Morpheus8 combines fine needles with radiofrequency energy delivered at a set depth beneath the skin surface. The intention is to prompt collagen remodelling in the layer where laxity originates, and it is used across the midface and jawline rather than only along the fold. Improvement builds over several months as new collagen forms, so it is a slow treatment by design.
Ultrasound and radiofrequency tightening
HIFU delivers focused ultrasound energy to deeper tissue layers, and Forma uses radiofrequency to heat the skin in a more controlled and gradual way. Both are aimed at lifting and firming rather than at filling. Which of them suits you depends on how much laxity there is and where it sits. You can read more about the options for skin tightening.
Resurfacing
Where the skin around the fold has fine lines, sun damage or an uneven texture, fractional resurfacing can improve the surface quality even though it does not change the depth of the crease. Sometimes the fold looks better simply because the skin around it looks better, particularly in photographs.
Which route suits which stage?
There is no fixed rule, but a few patterns come up often enough in consultation to be worth describing.
Someone in their thirties who has noticed the fold appearing in photographs, with good skin quality and no real slackness, is usually better served by collagen-stimulating treatment than by volume. Starting with filler at that stage often means committing to maintaining it for decades.
Someone in their forties or fifties with visible midface flattening as well as the fold generally needs the support restored, and energy-based treatment alone will not achieve that. The two are frequently combined, with tightening addressing the skin envelope and volume addressing the loss beneath it.
Where the fold has come on quickly after weight loss, the picture is different again, because the skin has been emptied faster than it can retract. Laxity is usually the dominant issue there rather than the crease itself.
Injectable treatments
Dermal fillers replace lost volume, and used well they are placed to support the midface rather than packed into the crease. That distinction is most of the difference between a natural result and the overfilled look people worry about.
At Pulse Light Clinic these are administered by doctors, and any conversation about them starts with an assessment rather than a price list. Product choice, placement, quantity and whether injectables are appropriate for you at all are medical decisions, which is why we do not publish them as a menu item.
What about creams and skincare?
Retinoids and a consistent daily sunscreen are worth using, and over years they make a measurable difference to skin quality. Neither will lift a descended fat pad. Skincare works at the surface, and the cause of a deepening nasolabial fold sits several millimetres below that, which is a limitation rather than a criticism.
If a product promises to lift the midface, that is marketing rather than pharmacology.
What is treatment actually like?
Radiofrequency microneedling is carried out under topical numbing cream, takes under an hour for the midface, and leaves the skin red and warm for a day or two with a faint grid pattern that fades. Most people are back to normal the following day and cover it with makeup after the first twenty-four hours.
Ultrasound tightening is felt as brief deep heat in pulses, which is uncomfortable rather than painful, and generally leaves nothing visible afterwards. Volume replacement involves swelling and the possibility of bruising for a few days, which is worth planning around if there is an event in the diary.
How long before anything shows?
It depends entirely on the route. Volume replacement is visible immediately, with swelling settling over the following days. Energy-based treatments work on a different clock: the skin is remodelling collagen for weeks and months afterwards, and the useful comparison is a photograph taken at the start rather than a daily look in the mirror.
Number of sessions varies with the treatment and with how your skin responds. That is agreed after an assessment, not before one.
What a realistic outcome looks like
Softened, not erased. The fold is a normal anatomical feature and removing it entirely would not look like a younger face, it would look like a face missing something. What treatment can do is reduce the shadow the crease casts and restore some of the support that has been lost above it.
Results vary between individuals, and anyone who tells you otherwise before examining your face is guessing.
Booking an assessment
Because the same fold can come from volume loss, from laxity, from skin quality, or from all three at once, the assessment is where the value sits. Two people with visually similar folds can need completely different treatment.
Pulse Light Clinic is CQC-registered and doctor-and-nurse-led, and has been treating patients in London since 2001.
Book a consultation to have your midface assessed and the options explained before committing to any treatment.
