Smile lines: why do they deepen, and what helps?
You can soften them, not erase them. The crease runs from your nose to the corner of your mouth. But the main cause isn’t the line at all. It sits in your cheek.
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What is a nasolabial fold?
It’s the smile line: the crease from the side of your nose down to the corner of your mouth. It shows most when you smile.
With age, the fat pads in your cheek thin out. A plastic surgery review says this loss makes the folds around the nose and mouth look more prominent.
Think of a cushion that has lost some stuffing: the cover sags and creases. The crease is the sign. The missing stuffing, in your cheek, is the cause.
| Layer | What happens with age |
|---|---|
| Cheek fat | Thins out, and the cheek droops. |
| Upper jaw bone | Sits further back as the face ages. |
| Skin | Sun and smoking thin it and break up its collagen (the protein that keeps skin firm). |
Sources: Farkas 2013; Yousif 1994
These layers age at different speeds in different people. So two people of the same age can have very different folds.
Filler can add back some lost cheek fullness. The skin part you can protect from today, with sunscreen and by not smoking.
Why do smile lines get deeper?
Ageing changes every layer. But some habits are linked to a face that looks older sooner.
A study of 186 pairs of identical twins compared twins with the same genes and different lives. It looked at how old each face seemed.
| Habit | What the study found |
|---|---|
| Smoking | The longer a twin smoked, the older they looked. |
| Sun | More sun, more outdoor time and less sunscreen went with an older look. |
| Weight | A 4-point higher BMI (a weight-for-height score) looked older under 40, but younger after 40. |
Source: Guyuron 2009
Smoking and sun damage thin the skin and break up its collagen. Those are the two habits you can change today. If you smoke, see what helps people stop.
Can creams or face exercises get rid of smile lines?
No. None of these trials measured the fold itself. They help the skin on top, or the cheek.
| Option | What the trial found |
|---|---|
| Daily sunscreen | 24% less skin ageing over 4.5 years than using sunscreen only when they chose, in 903 adults under 55. |
| Retinol cream | Crow’s feet fine lines 44% better after a year, in a trial of 62 people. |
| Face exercises | Fuller cheeks after 20 weeks, in 16 women aged 40 to 65. |
Sources: Hughes 2013; Randhawa 2015; Alam 2018
Sunscreen has the longest trial. The NHS says pick SPF 30 or more with at least 4-star UVA, and don’t rely on it alone. More in sunscreen and skin ageing.
Trying retinol? A skin doctor advises starting with a mild one every other night, slowly building up, and don’t use it in pregnancy. See retinol for beginners.
The face exercise study was small. Only 16 of 27 women finished, doing 30 minutes daily, then every other day. The programme’s founder helped write the study.
Nasolabial fold treatment: does filler work?
Yes, for a while. Filler is a gel injected under the skin to put back lost fullness.
Adding volume to the deep cheek fat lifts and smooths the fold. That’s the cushion getting its stuffing back.
In one trial, 97% of 75 people with moderate to severe folds responded well to hyaluronic acid filler (a type of gel filler). Results lasted up to 18 months with one top-up. A third had side effects, mainly swelling and bruising, and none were serious.
| Filler | How long it lasts |
|---|---|
| Hyaluronic acid gel | 4 to 12 months |
| Calcium hydroxylapatite | 6 months to 1 year |
| Poly-L-lactic acid | 1 to 3 years |
| PMMA | Permanent |
Source: American Academy of Dermatology
Ask which type you’re being offered. They differ in how long they last.
So plan for repeat visits. The NHS says to count the cost of any future treatment to keep the look.
Expect to pay privately. The NHS doesn’t routinely provide cosmetic surgery, and smile line filler is cosmetic. In England, filler for looks is illegal for under-18s.
How to choose who treats your smile lines
Serious problems are rare. A 2026 review puts severe ones from hyaluronic acid filler at fewer than 1 in 10,000 injection sites. But the NHS warns they can include infection, nerve damage and blindness.
The smile line is one of the riskier spots. It was the site in about 1 in 7 of 48 reported cases of sight loss after filler. That’s why who injects you matters.
Six NHS checks before smile line filler
- Book a consultation with the person who will inject you, and don’t pay before it.
- Check they’re on the JCCP or Save Face register, or a member of BAMAN (nurses) or BCAM (doctors).
- Ask the name of the filler and where the product came from.
- Ask how many they’ve done, and what to do if something goes wrong.
- Skip group events, online vouchers, home visits and social-media-only sellers.
- Take the cooling-off time after your consultation before you decide.
Sources: NHS: choosing who will do your procedure; NHS: before you have a procedure
Avoid anyone who has done only a short training course. For daily skin care, see skincare for ageing skin.
When to speak to a GP
A fold that deepens slowly over years is normal ageing. A change on one side that comes on fast is not.
- Call 999 if one side of the face suddenly droops, an arm is weak or speech is slurred. These can be signs of a stroke, even if they’ve stopped within the last 24 hours.
- Ask for an urgent GP appointment or use NHS 111 if one side of your face goes weak over a few days. It may be Bell’s palsy, and treatment works best within 72 hours.
- Go to A&E or call 999 if you suddenly cannot see from 1 or both eyes after filler. Get urgent medical help for bad pain or skin colour changes after filler. These were common signs in reported cases of sight loss.
- Speak to a GP if you’re unsure why you want filler. The NHS says a GP or mental health professional might be a good place to start.
Wondering about supplements for skin? See do collagen supplements work.