The nasolabial fold is the line running from each nostril to the corner of the mouth — present in every smiling face, and deepening at rest with age. Here is the counterintuitive truth of modern practice: the fold is usually the shadow of a problem happening above it, in the cheek — which is why the least sophisticated treatment is the one everyone asks for: filling the line itself.
WhatsApp Dr Sin Yong →Every face has this fold — it is where the mobile cheek meets the fixed upper lip, and it creases every time you smile. What changes with age is the traffic arriving from above: the cheek's fat compartments — discrete, named structures in the anatomical literature [2] — deflate and slide downward, and the descending tissue piles up against the fold like snow against a fence. The fold does not so much deepen as become the collection point for everything the mid-face is losing. That is why it appears alongside cheek volume loss and early jowling — three symptoms of one descent.
The intuitive treatment — inject the crease — treats the shadow and ignores the object. Meta-analytic evidence supports hyaluronic-acid fillers for nasolabial fold correction [1], but modern technique reads that evidence anatomically: restoring the deflated cheek above often softens the fold more naturally than loading the fold itself, because it removes the tissue traffic rather than padding the collection point. Direct fold treatment still has a role — conservative, deep, and structural — but as the finishing move, not the opening one. Overfilled folds and cheeks are precisely how faces end up in pillow face territory, and unpicking that costs more than doing it right once.
Assessment starts above the fold: how much is cheek deflation (restore support at the cheek and mid-face), how much is descent (the lifting conversation — VF Lift, HIFU-class energy), and how much is the fold's own etching (conservative structural filler at the fold, supported by the trial literature [1]). Skin-quality work — bio-remodelling, polynucleotides — improves how the crease reflects light. Most faces need the sequence, not a syringe in the line.
Face yoga against a structural fold — the crease is anatomy, not weakness. 'Smile line' creams — no topical reaches the fold's depth. Aggressive filling of the fold alone — the classic route to a heavy, simian mid-face that reads worse than the line did. And treating the fold while ignoring the deflating cheek above it — the traffic keeps arriving, and so do the appointments.
“The nasolabial fold is usually the shadow of the cheek above it — fill the shadow and you've padded the collection point while the descent continues.”
— Dr Sin Yong
The nasolabial fold is where I most often decline the treatment a patient arrives asking for. Filling the line is intuitive, quick to sell, and frequently wrong — the fold is usually collecting what the cheek above is losing. I treat the cause first, the crease last, and conservatively. It takes longer to explain than to inject, which is exactly why the explanation matters.
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Completely — every face makes them in animation at every age. The ageing change is when they carve in at rest. Treatment is elective aesthetics, never necessity.
Facial fat loss deflates the cheek compartments, and the deflating tissue settles against the fold. Significant weight loss commonly deepens nasolabial folds even as the body improves.
In experienced hands, with conservative technique, the trial evidence supports it — though this area contains the facial artery's path, which is exactly why anatomy-led injection matters here.
Overfilled folds flatten the natural transition between cheek and lip, producing the heavy 'monkey mouth' look. Restraint and treating the cause above the fold is the difference.
When descent is the driver, repositioning cheek tissue reduces what piles against the fold — often more naturally than any filler in the line.
The ageing process continues, so maintenance applies to every approach. Sequenced cause-first treatment tends to hold its result more gracefully than fold-stuffing.