Nose To Mouth Lines

Nasolabial folds are the creases that run from the sides of the nose down to the corners of the mouth. They are more commonly known as nose to mouth lines or smile lines. Everyone has them to some degree, because they are a normal part of facial anatomy, and they deepen whenever you smile. They only tend to become a concern when they settle into permanent lines that show even at rest. This is usually a sign of midface ageing rather than anything to worry about. The same loss of volume and support that softens the rest of the lower face is what makes these folds deeper over time. This is why treating them properly means addressing more than the surface alone. This is our complete guide to nasolabial folds. We explain what they are, why they form and every treatment option, from over-the-counter skincare through to surgery.

City Skin Clinic is an online skincare clinic. We provide and prescribe medical skincare and do not offer injectable treatments (dermal fillers or anti-wrinkle injections), energy-based devices or surgery. However, we have explained all the options below because we believe the public deserve clear, evidence-led information without commercial bias.

What’s the Difference Between Nasolabial Folds & Marionette Lines?

Nose to mouth lines and marionette lines are closely related and often confused, but they sit in different places. Nasolabial folds are the lines that run from the base of the nose to the corners of the mouth. Marionette lines run from the corners of the mouth straight down towards the chin. People sometimes use “smile lines” for either, although it most often means the nasolabial folds, because they deepen when you smile. Both come from the same loss of midface volume and skin support, so they tend to deepen together over time.

What Causes Nasolabial Folds?

Nose to mouth lines form through a mix of anatomy and ageing. Research shows that they deepen as the midface loses volume and the fat pads of the cheek slide downwards. The main causes of nose to mouth lines are:

• Midface volume loss & fat descent: The cheek fat pads that sit above the fold deflate and slip downwards with age. This piles soft tissue against the crease and makes it deeper. It is the single biggest driver of a deepening nasolabial fold and is closely linked to loss of face volume.
• Collagen & elastin loss: From the mid-20s the skin makes around 1% less collagen each year. As the skin thins and loses its spring, the fold sets into a permanent line.
• Facial anatomy: Nasolabial folds sit along a fixed boundary where the muscles of the lip attach to the skin. This is why everyone has them to some degree, even when young, and why they can’t be erased completely.
• Repeated movement & sun damage: Smiling folds the skin at the same line thousands of times, whilst UV drives up to 80% of visible skin ageing. Together these turn a dynamic crease into a fixed one.

Genetics, smoking and big fluctuations in weight then also how early and how deeply nose to mouth lines appear. In fact, how deep they eventually become is largely down to genetics.

How are Nasolabial Folds Treated?

Because nose to mouth lines come from volume loss as much as skin quality, the most effective plans usually combine treatments. The right combination depends on how deep the folds are and what is driving them. It helps to think of the options as a ladder. At the bottom is skincare, which improves the quality and thickness of the skin but can’t fill an established fold. Above that sit non-surgical procedures, where dermal filler can replace the lost volume directly. At the top is surgery, which repositions the deeper tissues when the midface has dropped significantly. We discuss each in detail below, starting with what you can do at home.

Can Over-the-Counter Skincare Improve Nasolabial Folds?

Over-the-counter skincare can’t fill a nose to mouth line, but it does improve the quality of the skin around it. Better skin quality softens the crease and slows it deepening. Used consistently, the right actives build collagen, smooth texture and even out tone. The actives worth looking out for are:

• Retinol: The most useful over-the-counter ingredient and a milder cousin of prescription tretinoin. The skin converts it into retinoic acid, though less efficiently, so it works more slowly. A 2025 network meta-analysis of topical anti-ageing treatments found that retinoids all improved fine wrinkles, with the prescription ones having the greatest effects. Retinol usually comes in strengths of between 0.1% to 1%.
• Vitamin C: This antioxidant typically comes at 10% to 20% strength in its most common form. It supports collagen production and brightens the skin.
• Niacinamide, ceramides & peptides: These ingredients help support the skin barrier and maintain firmness over time.
• Exfoliating acids: Agents like glycolic acid can help smooth surface texture and even out tone.
• Bakuchiol: This is a plant-derived compound that can help smooth skin and is useful for people who can’t tolerate retinoids or strong actives.

Above all, a daily broad-spectrum sunscreen with at least SPF 30 is the most important anti-ageing product. This is because it prevents the very damage the others are working to repair.

What Prescription Skincare Can Help Treat Nasolabial Folds?

Prescription skincare is the strongest skin-quality treatment you can use at home. For suitable patients, it sits at the centre of most anti-ageing protocols. The main active is tretinoin which is the most studied topical anti-ageing treatment in dermatology. It speeds up skin-cell turnover, boosts collagen and thickens the skin, which together smooth fine lines and improve tone. The evidence is strong and shows that topical tretinoin consistently improves wrinkling, pigmentation and skin texture. Because it is already in its active form, prescription tretinoin is also more effective than over-the-counter retinol. However, this means it carries a greater risk of side effects including irritation and burns which is why it is a prescription-only medicine.

Despite its benefits, tretinoin works on skin quality rather than volume. This means it will firm and thicken the skin and soften the fine creasing around the fold. It can’t, however, fill an established nasolabial fold or replace lost cheek volume. As such, it works best started early as a foundation or alongside the procedures below when the fold is deeper. Tretinoin is usually prescribed in strengths from 0.01% to 0.1%, either as a stand-alone product or combined with ingredients such as hydroquinone or niacinamide where there is hyperpigmentation alongside the lines.

Which Non-Surgical Treatments are Best for Nasolabial Folds?

Nose to mouth lines are driven mainly by lost volume, so non-surgical procedures can do something skincare can’t: replace what has been lost. Below are the best non-surgical treatments for nasolabial folds:

• Dermal fillers: This is the mainstay treatment for nose to mouth lines with plenty of scientific evidence showing it reliably improves them. Hyaluronic acid can be placed into the fold to soften it directly. It can also go into the cheek above to lift the midface and ease the pressure on the crease. Results are immediate and usually last 6 to 24 months depending on the product.
• Botulinum toxin: This has only a small role here. Relaxing certain muscles can soften the very top of the fold near the nose. It can’t touch the volume loss that drives the rest of it. The effect of these injections is also temporary and lasts 3 to 4 months.
• Energy-based devices: These tighten lax skin by heating the deeper layers to stimulate new collagen. Evidence suggests that over 90% of patients may experience mild tightening for up to a year after treatment. Again, these devices help the skin-quality side rather than filling the fold.
• Microneedling & thread lifts: Microneedling builds collagen to improve the skin around the fold and tighten it. Thread lifts can give a modest lift to a descended midface however they carry higher risks of soft tissue damage, infection and scarring.

All these non-surgical treatments for nose to mouth lines work best when matched to the cause. For example, filler are the best for lost volume and the others for skin quality. It is often best to pair them with good skincare for optimal outcomes.

When is Surgery the Best Option for Nasolabial Folds?

When the midface has dropped and the folds are deep, surgery offers the most complete and lasting correction. Two procedures address it, and they are often combined. A facelift (rhytidectomy) repositions the descended fat pads and tightens the deeper tissues. This lifts the cheek and softens the fold at its source. Fat grafting tackles the lost volume directly. A surgeon harvests a little of your own fat by liposuction and transfers it into the cheek to rebuild what has gone. Only around half of the transferred fat survives long term. It is sometimes topped up with a second session, but what takes then lasts for years.

These are operations rather than quick fixes. They carry more risk than skincare or injectables, need a recovery period and soften over time as the face keeps ageing. Research shows that the nasolabial and marionette areas stay well corrected even 5 years after a facelift. As such, surgery is usually reserved for deep folds with significant midface descent, or for anyone wanting the most complete change. It is a decision to make carefully with a qualified plastic surgeon.

Can You Prevent Nasolabial Folds?

You can’t prevent nose to mouth lines entirely, because they are partly anatomical, but you can slow how quickly they deepen. Daily broad-spectrum sunscreen (at least SPF 30) matters most, and it is the one step with the strongest evidence. Research shows that people who use sunscreen daily show no detectable increase in skin ageing compared with those who don’t. A retinoid, ideally prescription tretinoin, can also help build collagen over the years. Keeping your weight stable helps too, since repeated big swings deflate and stretch the midface that supports the fold. Ultimately, protecting the skin early does far more than any treatment begun once the folds are deep.

At City Skin Clinic, our doctors create personalised skincare to target skin ageing using actives like tretinoin where appropriate. Every plan begins with an online consultation and we build it around your skin and the concerns you most want to treat. Start your online consultation today. The journey towards great skin starts here.

This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical professional with any concerns about your skin or treatment options.