Nasolabial Folds

Nasolabial folds are the lines that run from the outer edge of each nostril down to the corners of the mouth. They are not strictly wrinkles, because they exist in everyone as the anatomical boundary between the cheek and upper lip. What changes with age is their depth. In youth, the cheek fat pads sit high and forward, producing a softly curved nasolabial line. With age, the deep medial cheek fat atrophies and the superficial cheek fat descends, which means tissue above the fold shrinks and tissue below the fold sags over it. The result is a deeper, more shadowed crease that becomes visible even in repose. Several factors influence how quickly nasolabial folds become prominent. Midface bone remodelling, particularly resorption of the maxilla just below the nose, reduces the skeletal platform supporting the cheek. Rapid weight loss accelerates the appearance because the cheek fat is among the first compartments to shrink. Sun damage reduces dermal quality and deepens the fold through cumulative collagen loss. Smoking produces both dermal damage and repeated contraction of the lip elevators, etching deeper perioral shadows. Sleep position can create an asymmetric fold over decades. Genetics set the starting anatomy, including the depth of the tear-trough to nasolabial continuum. Treatment is often misunderstood. Injecting filler directly into the fold itself, while tempting because it seems the obvious target, frequently produces a heavy, unnatural result and does not address the underlying cause. A considered approach treats the nasolabial fold indirectly by restoring the midface volume above it: dermal filler placed deep in the zygomatic region, along the medial cheek, and at the pyriform aperture just lateral to the nose, lifts the soft tissue off the underlying bone and softens the fold from above. Polynucleotides can be added to improve skin quality in the region, reducing the fine crepey lines that sometimes coexist with the main fold. For static etched-in lines, a small amount of superficial hyaluronic-acid filler or a bio-stimulator may be placed directly in the fold once midface volume has been restored, but this is a secondary manoeuvre rather than the primary one. Patients with very heavy jowling, pronounced lower face descent or thin lip skin should be assessed carefully because aggressive midface filler can make these adjacent issues worse. An honest consultation acknowledges where surgery would produce a cleaner result than repeated filler sessions.