Smile lines are one of the most common skin concerns that people seek anti-ageing treatments for. Also known as nasolabial folds, they are the creases that run from the sides of the nose to the corners of the mouth. They are of course a natural part of facial anatomy but for many people ingrained or deep folds are cosmetically bothersome. That’s why there’s a huge number of treatments and prodcts all promising to get rid of them. In this article, we’ll review what causes smile lines and the treatments that genuinely help.
Please note, we are an online skin clinic so we do not offer dermal fillers or other in-clinic procedures. We have written this because we believe people deserve clear, honest information about all of their options.
What Causes Smile Lines?
Smile lines are one of the earliest signs of facial ageing, and they tend to deepen gradually from our thirties onwards. Usually more than one thing is going on at once. The main causes are:
- Collagen & elastin loss: From our mid-twenties the body makes less collagen and elastin each year. The skin becomes thinner and less springy, so the fold sits deeper and recovers less well after each smile.
- Volume loss in the mid-face: This is the big one. As we age the deep fat pads in the cheek shrink and the superficial fat slides downwards, while the bone underneath quietly recedes. This descent of the fat compartments leaves the cheek less supported, so it sags over the nasolabial line and deepens it. The same loss of facial volume produces jowls and marionette lines lower down the face. That is why these concerns so often appear together.
- Repeated facial movement: Years of smiling, laughing and talking fold the skin in the same place over and over, and eventually the crease becomes set.
- Sun damage and lifestyle: Ultraviolet exposure, smoking and big swings in weight all break down collagen faster and make the folds more obvious.
Working out which of these is dominant matters, because each one responds to a different treatment. Most people have a mix of volume loss and skin-quality change, so a combination usually works best.
Dermal Fillers
Dermal fillers are the most direct non-surgical treatment for a deep smile line. They use hyaluronic acid, a gel-like substance found naturally in the skin. An experienced medical injector places the filler into the fold to soften the crease. They often treat the cheek too, restoring the mid-face support you have lost. Results are visible straight away. Depending on the product and your metabolism they last anywhere from around 6 months to well over a year. Hyaluronic acid is also dissolvable, so an uneven result can be corrected.
Filler works well for nasolabial folds, but it only addresses one cause. It restores volume. It won’t improve the texture or pigment of the skin, and on its own it can’t lift significant sagging. Overfilling the fold to chase a flat result tends to look heavy and puffy rather than younger. There are also real risks. The most serious is vascular occlusion, where filler blocks a blood vessel. This can cause tissue damage or, very rarely, affect vision. These risks are far lower in experienced medical hands, which is why this should only ever be done by a qualified practitioner.
Skincare for Smile Lines
Where the issue is skin quality rather than a deep hollow, skincare is the right and safest place to start. Retinoids like tretinoin and over the counter retinol build collagen and speed up cell turnover, which thickens the skin and softens fine lines over a few months. Daily sunscreen is essential, because ultraviolet light deepens every type of line. Antioxidants such as vitamin C protect against further damage and brighten the skin. A consistent routine for ageing skin built around retinoids and sun protection won’t erase a set fold. It can make smile lines less obvious though, and improve the result of every other treatment. For most signs of skin ageing, it is the foundation everything else is built on.
Skin Boosters
Skin boosters such as Profhilo and Volite are injectable treatments that improve overall skin quality rather than filling a fold. They deliver hyaluronic acid through fine microinjections to boost hydration and stimulate collagen and elastin. They can soften mild smile lines and give the skin a fresher, more hydrated look. For deep folds they work best alongside filler rather than instead of it.
Botox
Botox relaxes the muscles that create expression lines. It is excellent for dynamic wrinkles like crow’s feet and frown lines. It is not a primary treatment for the nasolabial fold itself though. That fold is largely about volume and skin rather than muscle pull. Injected carelessly near the upper lip it can even weaken the smile. Its role here is supporting rather than central, softening some of the associated lines around the mouth.
Chemical Peels
Chemical peels use a solution to exfoliate the surface layers of skin. This improves texture and tone, and can soften fine lines over a course of treatments. They help with skin quality and mild lines. They won’t shift a deep fold. You will normally need several sessions, and they should be done by a qualified practitioner to avoid burns, scarring or post-inflammatory hyperpigmentation.
Microneedling and Radiofrequency
Microneedling creates tiny controlled injuries in the skin that trigger collagen production, which thickens the skin and improves its quality over time. Radiofrequency adds heat to the deeper layers to tighten and stimulate collagen further, and the two are often combined as radiofrequency microneedling. Both gradually improve the appearance of smile lines rather than filling them. As with peels, you’ll need a course of sessions and a properly trained practitioner.
Laser Resurfacing
Laser treatments heat the deeper layers of the skin to stimulate collagen and resurface the surface texture. Non-ablative fractional lasers do this while leaving the surface largely intact, which keeps downtime shorter. Results build over several sessions rather than appearing straight away. Like the other energy treatments, laser improves skin quality and can soften lines, but it doesn’t replace lost volume.
Surgery
When significant sagging is the cause, surgery is the only thing that truly lifts the tissue back into place. A facelift repositions the deeper structures of the mid and lower face and can give long-lasting results. The trade-off is that it is an operation, with anaesthetic, recovery time and the usual surgical risks. For most people it is reserved for advanced sagging, and a combination of skincare and a little filler where appropriate is enough.
There is no single best treatment, because it depends on what is causing your smile lines and how deep they are. If it’s a deep fold from volume loss, filler is the most direct fix. If it’s skin quality and early lines, skincare is the right and safest starting point, and the foundation for everything else. Energy treatments like microneedling, radiofrequency and laser, along with peels and skin boosters, gradually improve the skin around the fold. And if true sagging is the problem, only surgery will lift it. Smile lines rarely sit on their own. It is worth looking at other manifestations of facial volume loss like tear troughs, jowls and the rest of the ageing face together. Treating one line in isolation rarely gives the most natural result. The sensible first step is an honest assessment with a qualified professional who can tell you what’s actually driving yours.
Whilst smile lines are a natural part of getting older, there is a lot you can do to soften them and slow their progress. Good skincare and sun protection are within everyone’s reach, and they make a real, lasting difference whether or not you ever choose a procedure.
At City Skin Clinic, we don’t provide dermal fillers, injectables or in-clinic procedures. We do however offer personalised skin ageing treatments through our online skin clinic. Our doctors design custom topical formulas using ingredients like tretinoin and azelaic acid where appropriate, tailored to suit your individual needs. Start a virtual consultation with one of our doctors for a personalised treatment protocol. 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 provider for any medical concerns or questions you might have.
