Deep Nasolabial Folds: Why They Appear and How to Treat Them Safely

Every morning in the mirror, you notice two lines running from the sides of the nose down to the corners of the mouth becoming more pronounced — even when your face is at rest and not smiling. Deep nasolabial folds are one of the signs of aging that make many people feel they look older than their actual age, tired, and less fresh. What many people wonder is: why do these lines form, and is there a scientific, safe way to address them rather than relying on creams alone? This article will help you understand the true nature of the problem.

What Are Nasolabial Folds, and When Are They Considered Deep

The nasolabial folds (the medical term is nasolabial fold) are two natural creases that run from each side of the nose down to the corners of the mouth. This is a normal anatomical structure that everyone has, and it helps the face express emotion when smiling and talking.

A concern only arises when these folds become deeply etched and visible even when the face is relaxed. At that point, others may perceive you as looking sad, stern, or older than you actually are.

• Shallow folds that appear only when smiling: usually a natural anatomical feature.
• Folds clearly etched when the face is at rest: a sign of the aging process or a loss of volume in the cheek area.
• Folds accompanied by loose, sagging skin below the cheekbone: related to aging across multiple tissue layers.

Why Deep Nasolabial Folds Appear Over Time

Understanding the causes is the first step toward choosing a suitable approach. Deep nasolabial folds are rarely due to a single factor; they are usually the combined result of several changes across the face.

Loss of Fat and Volume in the Cheek Area

Our cheeks have natural fat pads that support the midface. With age, these fat pads shrink and slide downward. When the support above deflates, the cheek tissue is pushed down toward the corners of the mouth, making the nasolabial folds deeper.

Skin Aging and Declining Collagen

From around age 25 onward, the amount of collagen and elastin in the skin gradually decreases. The skin loses elasticity and becomes thinner and weaker, so it can no longer hold up the underlying structures, deepening the nasolabial fold.

Soft Tissue Sagging and Bone Resorption

Gravity pulls the tissue layers downward over the years. At the same time, the jawbone and cheekbone also gradually lose volume, causing the facial "framework" to shrink. As a result, skin and fat sag and gather around the nasolabial fold area.

In addition, certain habits can accelerate this process:

• Smoking, which damages collagen and the blood vessels that nourish the skin.
• Frequent sun exposure without proper sun protection.
• Rapid weight loss, which causes the cheeks to suddenly become hollow.
• Genetic factors and each person's individual facial anatomy.

Evidence-Based Methods for Treating Deep Nasolabial Folds

Because deep nasolabial folds stem from several different causes, there is no one-size-fits-all solution for everyone. The doctor needs to examine you directly to determine whether you have a lack of volume, loose skin, or both, and then advise on a suitable approach. Below are three common groups of methods.

Filler Injection (Dermal Fillers)

Hyaluronic acid filler is injected to restore the missing volume, making the nasolabial folds shallower. This is a minimally invasive method with a quick procedure time and relatively short recovery.

• Suitable for folds caused by mild to moderate volume loss.
• Results are temporary and usually need to be maintained with repeat treatments over time.
• It is essential to use products of clear origin and to have the procedure performed by a doctor, because this area has many blood vessels, and incorrect injection technique can cause serious complications.

Autologous Fat Grafting

The doctor harvests fat from another area of the body (such as the abdomen or thighs), processes it, and then grafts it into the cheek and nasolabial fold area. This method restores volume using the patient's own tissue, so it looks natural while also improving skin quality thanks to factors within the fat tissue.

• Suitable when more durable restoration of midface volume is needed.
• Part of the grafted fat may be reabsorbed, so an additional procedure is sometimes needed.
• It is an invasive procedure that must be performed in a properly sterile environment.

Muscle Suspension and Tissue Tightening (Facial Lifting)

When the main cause is loose skin and tissue descent, suspension techniques, tissue tightening, or a facelift procedure can lift the structures back to their proper position, thereby reducing the depth of the nasolabial folds. This is a more specialized intervention, intended for pronounced degrees of aging.

• Suitable for people with significant skin laxity, not just a lack of volume.
• A thorough assessment of the overall face is needed before deciding.
• It requires a specialist in aesthetic plastic surgery and a properly accredited surgical facility.

In practice, many cases require a combination of methods to achieve harmony. The cost of each approach also varies depending on the degree and technique, so the best course is to receive specific advice after an examination.

Medical Notes: Contraindications, Risks, and Complications

Every intervention on the nasolabial folds, even one as gentle as filler injection, is a medical procedure and carries certain risks. Being honest about this matters more than any promise.

Some cases require caution or should not undergo treatment:

• Women who are pregnant or breastfeeding.
• People with an active infection or skin inflammation in the area intended for treatment.
• People with bleeding disorders, uncontrolled underlying conditions, or autoimmune diseases.
• People with a history of allergy to the components of the product being used.
• People with unrealistic expectations about the results.

Possible risks and complications include local swelling, bruising, and pain; infection; an asymmetrical result; and firm nodules under the skin. With filler, the most concerning complication is accidental injection into a blood vessel, causing vascular occlusion that can lead to skin necrosis or affect vision — rare but very serious. This is precisely why the nasolabial fold area must be treated by a specialist who has a thorough grasp of the anatomy, in a hospital or properly accredited medical facility, and absolutely not at a spa or an unlicensed establishment.

The results of every method depend on each individual's constitution, degree of aging, and capacity for recovery. No solution suits everyone, and a direct examination is a mandatory condition for receiving proper advice.

When You Should See a Doctor About Deep Nasolabial Folds

If deep nasolabial folds are undermining your confidence and ordinary skincare measures no longer make a difference, it is time to talk with a specialist. You should consider an examination when:

• The folds are clearly etched even when the face is at rest.
• The cheek area above shows signs of hollowing or sagging.
• You want to clearly understand your own specific causes before deciding on any intervention.

An early examination helps you understand your true condition and choose a suitable direction, rather than chasing advertisements that promise too much.

Closing Words and an Invitation to Visit

Deep nasolabial folds are a natural sign of aging, but they can certainly be improved when properly assessed and treated. What matters is not choosing the most "trendy" method, but choosing the solution that fits your true cause, performed by a specialist in a safe medical environment.

If you would like to have your nasolabial fold condition assessed and to receive advice on an approach suited to your individual constitution, please book an in-person examination with Dr. Vo Thanh Sang — a Level I specialist in aesthetic plastic surgery. Contact the hotline 079 7479 222 to be listened to and advised with care.