What Are Nasolabial Folds? Causes, Stages, and How to Treat Smile Lines

According to dermatology experts, the creases running from the sides of the nose to the corners of the mouth are one of the most visible early signs of facial aging, and most adults start noticing them well before any gray hair appears. What surprises many people is that these lines are not caused by expression alone — they are largely the result of structural changes happening beneath the skin, including shifting fat pads and thinning collagen. Understanding what nasolabial folds actually are, why they form, and how severity is typically graded can help you make more informed choices about skincare and, if you choose to pursue it, professional treatment. This guide breaks down the anatomy, the classification stages, the root causes, and the realistic options available at every level.

What Are Nasolabial Folds?

Nasolabial folds, commonly called smile lines or laugh lines, are the two creases that extend diagonally from the sides of the nostrils down to the corners of the mouth. They exist on virtually every face to some degree, since they mark the natural boundary between the cheek and the upper lip region, but they become more pronounced and permanent as the skin ages. In younger faces, these folds usually appear only when smiling or making other expressions and disappear at rest — this is considered a normal anatomical feature rather than a sign of aging.

The underlying anatomy involves several layers working together. Beneath the skin sits a network of superficial fat compartments that give the midface its youthful, rounded contour. Deeper still, a supportive layer of collagen and elastin fibers keeps skin firm and resilient, while facial ligaments anchor tissue to the underlying bone. As these support structures weaken over time — through a combination of gravity, fat pad descent, collagen depletion, and gradual bone remodeling around the midface — the tissue above the nasolabial crease begins to sag forward and downward, deepening the line and making it visible even when the face is relaxed.

Stage 1: Mild folds (typically age 20s to early 30s)

Signs: The fold is visible only during smiling or animated expression and flattens out completely when the face is at rest. Skin texture and elasticity in the area remain largely intact.

Clinical mechanism: At this stage, the crease is primarily a dynamic feature caused by the natural movement of underlying muscles (particularly the levator muscles around the mouth) rather than by structural tissue loss. Collagen production is still relatively robust.

Stage 2: Moderate folds (typically mid-30s to mid-40s)

Signs: The line becomes faintly visible at rest and more defined when smiling. Some early volume loss in the cheek may be noticeable, along with a subtle blurring of the smooth cheek-to-lip transition.

Clinical mechanism: Collagen and elastin synthesis begins to slow measurably during this window, and the superficial fat pads start to descend slightly due to weakening of the ligaments that hold them in place. Sun exposure accumulated over decades often accelerates this stage.

Stage 3: Pronounced folds (typically late 40s to 50s)

Signs: The fold is clearly visible at rest, often accompanied by mild jowling or a less defined jawline. Skin in the area may appear thinner or looser.

Clinical mechanism: Deeper fat compartments continue shifting downward, skin laxity increases due to substantial collagen loss, and in many people the underlying facial bone — particularly around the nasal aperture and maxilla — undergoes gradual resorption, removing some of the scaffolding that once supported the overlying tissue.

Stage 4: Severe or deep folds (typically 55+, though this varies widely)

Signs: A deep, shadowed groove is present at all times, frequently paired with drooping cheek volume, marionette lines, and a heavier lower face contour.

Clinical mechanism: This stage reflects the cumulative effect of decades of collagen decline, ligament laxity, fat pad migration, and bone remodeling acting together, compounded in many cases by lifestyle factors such as long-term sun exposure or smoking.

It’s worth noting these age ranges are general guidelines, not fixed rules — genetics, sun habits, and lifestyle can shift a person into a more advanced stage earlier, or keep folds milder well past the typical range.

What Causes Nasolabial Folds?

Nasolabial folds develop from a mix of intrinsic aging and external, modifiable factors. The American Academy of Dermatology (AAD) notes that visible facial aging results from a combination of genetically programmed skin changes and cumulative environmental exposure, and dermatology research indexed on PubMed consistently points to collagen degradation and photodamage as two of the strongest contributors to midface folds. The main contributing factors include:

1. Natural aging and collagen loss: Collagen and elastin production declines gradually from the mid-20s onward, accelerating around and after menopause for women and with a slower, steadier decline for men. This is considered the single largest driver of nasolabial fold formation over a lifetime.
2. Cumulative sun damage (photoaging): Ultraviolet exposure breaks down collagen fibers and impairs the skin’s ability to repair itself, a process dermatologists refer to as photoaging. Years of unprotected sun exposure can make folds appear 5 to 10 years more advanced than a person’s chronological age would suggest.
3. Genetics: Bone structure, skin thickness, and the natural strength of facial ligaments are all inherited traits, which is why some people develop deep folds in their 30s while others show minimal folds well into their 50s or 60s.
4. Weight fluctuation: Significant or repeated weight gain and loss stretches the skin and fat pads in the midface; when the skin loses elasticity, it does not always retract fully afterward, which can leave folds more pronounced.
5. Smoking: Tobacco use restricts blood flow to the skin and directly accelerates the breakdown of collagen, and dermatology sources consistently list it among the most modifiable risk factors for premature facial wrinkling.
6. Repeated facial expressions: Smiling, talking, and other habitual movements create dynamic creases over time; while a normal and healthy part of expression, very frequent repetition can contribute to earlier, more defined static lines.
7. Bone resorption in the midface: As people age, the bone around the nasal opening and upper jaw gradually loses density and volume, reducing the underlying support for the overlying soft tissue and deepening the fold from beneath.

How to Improve Nasolabial Folds

At-home care

For mild to moderate folds, a consistent skincare routine can help slow further progression and improve skin quality, though it is unlikely to fully reverse established structural changes. Daily broad-spectrum sunscreen (SPF 30 or higher) is widely regarded by dermatologists as the single most effective preventive step, since it limits ongoing collagen breakdown. Topical retinoids (over-the-counter retinol or prescription-strength options) are among the most researched actives for stimulating collagen renewal and improving fine lines with consistent use over several months. Vitamin C serums support antioxidant protection and may improve skin brightness and firmness, while peptide-based moisturizers are often used to support the skin’s barrier and elasticity. Facial massage and gua sha are popular for temporary plumping and circulation, though their long-term structural effect is limited. Maintaining stable body weight, staying well hydrated, avoiding smoking, and getting adequate sleep also support overall skin resilience.

Professional and clinical intervention

For moderate to severe folds where at-home care has limited effect, several categories of professional treatment exist, and the appropriate option generally depends on the severity stage described above. For mild to moderate folds, energy-based devices (such as radiofrequency or laser treatments) and light chemical peels are sometimes used to stimulate collagen production non-invasively. For moderate folds with visible volume loss, dermal fillers are commonly used to restore lost volume in the cheek and soften the crease; results are temporary and vary by product and individual anatomy. For more advanced laxity, thread lifts offer a less invasive option to reposition sagging tissue, while surgical approaches such as a mid-face or lower face lift are typically reserved for severe, structural cases where non-surgical options are unlikely to provide sufficient improvement. Any injectable or energy-based treatment carries risks such as bruising, asymmetry, or, rarely, more serious complications, and outcomes depend heavily on practitioner skill and individual anatomy — as covered in our broader guide to wrinkle-removal methods, choosing the right approach should always follow a proper in-person assessment rather than a one-size-fits-all recommendation.

Frequently Asked Questions

Can nasolabial folds be reversed naturally?

Mild, expression-related folds can improve somewhat with consistent sun protection, retinoids, and healthy lifestyle habits, since these support collagen production and skin elasticity. However, folds caused by structural changes like fat pad descent or bone resorption generally cannot be fully reversed through skincare alone, and professional evaluation is the best way to understand realistic expectations for your specific case.

At what age do nasolabial folds start forming?

Faint, expression-only folds can appear as early as the 20s, but most people begin noticing folds that persist at rest sometime in their mid-30s to mid-40s. The exact timing varies significantly based on genetics, sun exposure history, weight changes, and smoking status, so there is no single ‘normal’ age.

Is filler or a thread lift better for smile lines?

It depends on the underlying cause and severity. Dermal fillers are generally better suited for folds caused mainly by volume loss, offering a relatively quick, temporary improvement. Thread lifts are often considered for cases involving more visible skin laxity or sagging, since they aim to reposition tissue rather than simply add volume. A licensed provider can assess which mechanism is actually driving your folds before recommending either option.

Do nasolabial folds mean I am aging badly?

No — nasolabial folds are a near-universal part of facial anatomy and aging, not an indicator of poor skin health or care. Even people with excellent skincare habits and healthy lifestyles develop them over time, since they are driven largely by structural changes like collagen decline and fat pad movement that affect virtually everyone to some degree.

Nasolabial folds are a normal, gradual part of facial aging, and their severity can vary widely from person to person based on genetics, sun exposure, and lifestyle. If you’re noticing your smile lines becoming more visible and want to understand which stage they fall into and which options — from skincare adjustments to professional treatments — might suit your skin, the team at SERYN can provide a personalized, in-person assessment to help you decide on the right next step.

This article is for general educational purposes only and does not constitute medical advice. Individual results from any skincare routine or clinical treatment vary and cannot be guaranteed. Please consult a licensed dermatologist or qualified physician before starting any new treatment to determine what is appropriate and safe for your specific skin and health history.

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