Smile Lines (Nasolabial Folds): Causes, Types & Every Treatment Option
Smile lines, also called nasolabial folds or laugh lines, are the creases that run from the sides of the nose to the corners of the mouth. Everyone has them to some degree, because they mark where cheek tissue meets the upper lip. They deepen with age, sun damage, smoking and volume loss. Treatment ranges from skincare and filler to surgery.
| Treatment | US cost guide | Downtime | How long it lasts |
|---|---|---|---|
| Hyaluronic acid filler | Average $715 per treatment (2023) | Bruising and swelling, usually under a week | About 9 to 12 months |
| Laser resurfacing | Average $1,829 | About 1 to 2 weeks | Long-lasting with sun protection |
| Fat grafting | $3,000 to $5,500 (2024 range) | Swelling for weeks | Variable; some fat is reabsorbed |
| Facelift | Average $11,395 (2023) | About 2 weeks off work | Years |
| Retinoid skincare | Low | None to mild irritation | Only while used |
Costs are surgeon fees from the American Society of Plastic Surgeons (ASPS, US) and exclude anaesthesia and facility fees.
What are smile lines?
These are natural folds between the cheek and upper lip; they’re normal at any age and only become a concern when they look deep at rest.
The fold forms because the skin below it is firmly attached to the muscle around the mouth, while the cheek above it is looser. A 2024 anatomy review in Diagnostics notes that in youth these lines may be prominently visible only during smiling. Many people find smile lines cute or a sign of a warm face, and they’re part of natural beauty. Others notice smile lines wrinkles deepening with age and want them softer.
A fold and a wrinkle differ. A wrinkle is a fine crease in the skin itself. A fold is a deeper shape change caused by fat, muscle and bone underneath, which is why skin creams alone rarely flatten it.
Types and locations
The main smile lines types include folds beside the nose, lines around the mouth, vertical lines toward the chin and crow’s feet beside the eyes.
The same review describes three anatomical types of nasolabial fold:
- Volume loss: a hollow beside the nostril, partly from the shape of the upper jawbone.
- Sagging cheek: loose cheek tissue above the fold slides down and overhangs it.
- Muscle pull: the muscles that lift the upper lip tug on the skin and deepen the fold when you smile.
The authors note a combination of the second and third is most common. People also use smile lines around nose, smile lines near mouth and smile lines face to mean the same fold. Lines running down from the mouth corners toward the chin are usually called marionette lines, and some people call them vertical smile lines or smile lines chin. Lines around the eyes, or crow’s feet, have a different cause; see our guide to smile lines around the eyes. Folds are often more visible in side profile, where cheek fullness casts a shadow. If you’re unsure whether a crease is a dimple or a fold, read smile lines vs dimples.
Causes
Folds deepen with age, sun exposure, smoking, weight change and genetics, plus years of repeated smiling as skin loses its spring.
- Aging: skin becomes drier and less elastic, with less collagen, according to Mayo Clinic. Facial ligaments also lose resilience, so cheek tissue sags.
- Repeated expressions: Mayo Clinic explains that smiling and squinting create grooves that become lasting lines as skin loses flexibility.
- Sun: ultraviolet light breaks down collagen and elastin.
- Smoking: in a 2013 study of 79 identical twin pairs, smokers had deeper nasolabial folds than their non-smoking twins.
- Genes and face shape: family history affects skin and bone structure.
Visible smile lines in your teens or twenties are usually a sign of anatomy and expression, not early aging. Our guide to smile lines at a young age covers this, and smile lines in men explains differences in male skin. The smile lines women notice after weight loss or pregnancy often reflect volume loss in the cheek.
Treatments overview
Treatment matches the cause: filler for volume loss, lifting for sagging, laser for skin quality and surgery for heavy folds.
Hyaluronic acid (HA) filler is the most common in-office option. The US Food and Drug Administration (FDA) lists nasolabial folds among approved uses for absorbable fillers in adults 22 and over. A 2024 network meta-analysis of 13 randomised trials concluded that HA is a safe filler for these folds. Details are in our smile lines filler guide.
For deep smile lines, options include subcision, fat grafting, laser resurfacing, a midface lift or facelift. Our smile lines treatment comparison sets them side by side, and how to get rid of smile lines ranks every option. In my practice, I often find that treating the cheek above the fold gives a more natural result than filling the line directly.
Fillers carry rare but serious risks. Injection into a blood vessel can cause skin damage or vision loss, so choose a qualified, experienced injector.
At-home options
Sunscreen, retinoids and not smoking help skin quality, but no cream, exercise or makeup removes a fold caused by fat and bone.
Mayo Clinic recommends daily broad-spectrum sunscreen of SPF 30 or more, a moisturiser and products with retinol, niacinamide or vitamin C, with results taking weeks to months. In a 2007 trial, 0.4% retinol lotion improved fine wrinkles on aged skin after 24 weeks. See our skincare for smile lines guide.
Face yoga and massage have little evidence; read smile lines exercises for what studies show. To hide lines for a day, our smile lines makeup guide explains how to stop foundation creasing. For context, many well-known faces have visible folds too; see why smile lines are normal.
Frequently Asked Questions
FAQ
Answers on whether smile lines are normal, what age they appear, the fastest treatment and how long results last.
Are smile lines normal?
Yes. Everyone has a nasolabial fold, because it marks where the cheek meets the upper lip. It shows more when you smile and usually deepens with age. It’s only a medical concern if it bothers you, and then treatment is cosmetic and optional.
At what age do smile lines appear?
They can show in childhood when smiling. Lines that stay at rest usually appear from the thirties onward, earlier with heavy sun exposure, smoking, rapid weight loss or a family tendency. Young people with full cheeks often have more visible folds.
What is the fastest way to soften smile lines?
Hyaluronic acid filler shows results right away, with possible bruising and swelling for a few days. It’s temporary, lasting about nine months to a year in the main product study. Makeup gives an instant but one-day effect.
Can smile lines be removed permanently?
Not completely, because the fold is part of normal anatomy and the face keeps aging. Surgery such as a facelift lasts longest; a 2012 study found nasolabial improvement held up well at about five years. Fillers and lasers need repeat sessions.
Do smile lines get deeper if I smile a lot?
Repeated expressions contribute to lasting lines as skin loses elasticity, according to Mayo Clinic. Stopping smiling isn’t the answer. Sun protection, not smoking and good skincare do more to protect the skin over time.
Guides in this series
Explore every treatment option, home care, makeup tips, causes at a young age and how smile lines differ in men.
- How to get rid of smile lines
- Filler for smile lines: before and after
- Laser, subcision, fat transfer and surgery compared
- How to stop makeup creasing in smile lines
- Skincare for smile lines
- Dimples versus smile lines
- Facial exercises for smile lines
- Crow’s feet: lines around the eyes
- Early smile lines at 15 to 20
- Men and smile lines
- Celebrities with smile lines
If you’d like to know which type of fold you have, you can book a consultation with Metropole Clinic by ABmedi.
This article is for general education and does not replace a personal medical consultation.
References
Show sources
- Hong GW, Song S, Park SY, et al. Why Do Nasolabial Folds Appear? Exploring the Anatomical Perspectives and the Role of Thread-Based Interventions. Diagnostics. 2024;14(7):716. mdpi.com
- Wrinkles: Symptoms and causes. Mayo Clinic. 2023. mayoclinic.org
- Face it: Twins who smoke look older, says study in Plastic and Reconstructive Surgery. Newswise. 2013. newswise.com
- Dermal Fillers (Soft Tissue Fillers). US Food and Drug Administration. fda.gov
- Li MY, Chien WY, Kang YN, et al. Efficacy and Safety of Fillers for the Treatment of Nasolabial Folds: A Network Meta-Analysis of Randomized Controlled Trials. Aesthetic Plast Surg. 2024. link.springer.com
- About JUVÉDERM Ultra XC for Facial Wrinkles and Folds. Patient labeling. AbbVie. 2023. rxabbvie.com
- Kafi R, Kwak HSR, Schumacher WE, et al. Improvement of naturally aged skin with vitamin A (retinol). Arch Dermatol. 2007;143(5):606-612. pure.johnshopkins.edu
- 2023 Cosmetic Procedures: Average Cost. American Society of Plastic Surgeons (ASPS, US). 2024. plasticsurgery.org
- Journal report finds patients still look younger five years after facelift surgery. ASPS. 2012. plasticsurgery.org
