Published 24 September 2026 · Reviewed by Dr Sin Yong
The two lines that bother people most — the nasolabial fold running from nose to mouth corner, and the marionette line running from mouth corner toward the jaw — share a secret: they are mostly not problems of the crease itself. They are where descending midface tissue comes to rest. Treat the crease and ignore the descent, and you get the heavy, monkey-ish lower face everyone fears. Treat the cause, and the crease softens almost as a side effect.
The fold is assessed as a consequence — where is the tissue above it coming from?
Smile lines, or nasolabial folds, usually reflect three things: lost volume in the cheek compartments above them, laxity of the skin and soft tissue, and repeated muscle movement around the mouth. Getting rid of smile lines means treating whichever dominates, often cheek support first, rather than filling the crease alone. Some line is normal in every adult face.
Key facts
Nasolabial fold
The line from nostril to mouth corner — the landing zone of descending malar (cheek) fat
Marionette line
The line from mouth corner toward the jaw — named for a puppet's hinged mouth
Facial fat compartments
Facial fat sits in discrete compartments that age, deflate and descend independently
Midface descent
Cheek compartments losing volume and position with age — the upstream cause of both lines
Direct filling
Filler placed in the fold itself — useful in moderation, heavy-looking in excess
Structural support
Restoring cheek projection and lateral support so less tissue collapses onto the fold
DAO muscle
Depressor anguli oris — pulls mouth corners down; a contributor to marionette heaviness
Why these lines form
Rohrich and Pessa's anatomical work established that facial fat is not one sheet but a mosaic of separate compartments — and they age separately. The midface compartments deflate and slide downward and inward with the years; the nasolabial fold is quite literally where that migrating tissue folds against the fixed anatomy around the mouth. The marionette line is the same story one act later, with the added pull of the depressor anguli oris muscle dragging the mouth corners down. Neither line is primarily a 'line problem' — they are the visible creases of a structural shift happening above them.
Why filling the crease alone disappoints
Direct filler into a deep fold does something — but the physics is unforgiving. The tissue above the fold is still descending, still pressing down; filler placed only in the crease lifts the crease floor toward tissue that keeps arriving. Chase the fold with syringe after syringe and the whole zone grows heavy, blurring the border between cheek and mouth — the overfilled lower face that photographs so unkindly. Restraint here is not caution for its own sake; it is respect for where the tissue is coming from.
“The nasolabial fold is where the descending cheek lands. Filling the landing site while ignoring the descent is how faces get heavy.”
Dr Sin YongOn treating causes, not creases
Treating the cause: support first
Cause-first treatment starts higher: restoring the deflated cheek compartments and lateral support so that less tissue collapses onto the fold in the first place. Structural volumisation at the midface, lifting energy where laxity dominates, threads where a vector of reposition helps — the combination is chosen by what the assessment finds, and a modest amount of direct fold work then finishes what the structural work began. For marionette heaviness, relaxing an overactive DAO adds a subtle but real upturn to the mouth corners. The consistent principle: the crease receives the least filler of anywhere in the plan.
What honest results look like
Done cause-first, the change reads as 'rested' rather than 'done' — the shadow of the fold lightens, the mouth corners stop looking stern, and the cheek regains the gentle forward curve that photographs as youth. The fold itself does not vanish; a visible nasolabial line is present in every adult face, including twenty-year-old ones, and erasing it entirely is neither possible nor desirable. Anyone promising a creaseless lower face is promising a strange one.
Can skincare or face exercises get rid of smile lines?
Skincare and face exercises cannot remove a smile line, because the main causes sit deeper than either reaches. A nasolabial fold forms where descending cheek tissue meets the fixed anatomy around the mouth; no cream restores deflated fat compartments, and no exercise reverses laxity in the supporting tissue.
Skincare still has a role at the level of the skin. Daily sunscreen limits ultraviolet damage to collagen, and a prescription or over-the-counter retinoid can improve fine surface lines and texture over months, but neither changes the depth of a fold cast by a shift in volume. Facial exercise programmes are popular, yet the evidence for them is limited, and repeated strong smiling and puckering work the same muscles that deepen expression lines. Massage tools and tapes may reduce puffiness briefly without changing structure. Rapid weight loss and smoking also influence how the lower face ages. Where a line bothers you, assessment identifies which of volume, laxity or movement is driving it, and that decides whether filler, energy-based lifting, threads or botulinum toxin is relevant at all.
Smile line and marionette line treatments compared by cause
Option
What it does
What it cannot do
Typical recovery
Who it tends to suit
Midface structural volumisation (dermal filler in the cheek)
Restores support in deflated cheek compartments so less tissue folds onto the nasolabial line
Does not tighten lax skin or change muscle pull at the mouth corners
Possible swelling or bruising at injection points that settles
Smile lines driven mainly by volume loss in the cheek
Direct filler in the fold, in moderation
Softens the remaining shadow once structural support is in place
Cannot counter tissue still descending from above; repeated filling makes the lower face heavy
As for other filler
A residual crease after midface work
Energy-based lifting, such as VF Lift – Vertical Facelift (Volnewmer monopolar radiofrequency)
Heats the dermis and subcutaneous layer to prompt collagen remodelling where laxity dominates
Does not replace lost volume or relax muscle
Usually transient redness and warmth
Lines linked to laxity and loss of firmness
Thread lift (The Bliss Lift)
Absorbable threads reposition descended midface tissue along a chosen vector
Does not restore volume or improve skin quality
Swelling, tenderness or bruising along the thread paths
Moderate descent where repositioning helps
Botulinum toxin to the depressor anguli oris
Relaxes the muscle that pulls the mouth corners down
Does not treat the nasolabial fold itself or replace volume
Small injection marks; the effect develops over the following days
Marionette lines with downturned mouth corners
Surgical facelift (referred to a plastic surgery specialist)
Repositions deeper tissue and removes excess skin surgically
Is not a non-surgical option, and does not restore volume on its own
A formal surgical recovery set by the operating team
Advanced laxity beyond what non-surgical approaches address
Chiefly the age-related deflation and descent of the cheek's fat compartments — the folds are where that migrating tissue creases against fixed anatomy around the mouth. Muscle pull (the DAO dragging mouth corners down) and skin-quality change contribute, particularly to marionette lines.
No — and it should not try. Every adult face has some nasolabial line; erasing it entirely requires so much filler that the lower face turns heavy and unnatural. The realistic goal is a softer shadow and a rebalanced midface, not a creaseless one.
Usually proportion: adding volume in the wrong plane or place can push tissue toward the fold, deepening its shadow. It is also possible to become more critical of a zone once attention is drawn to it. A structural review maps what is actually contributing before adding anything further.
It depends on the dominant cause: structural support and careful volumisation where descent dominates, DAO relaxation where muscle pull turns the corners down, skin-quality treatment where fine crepiness is the issue — and usually a measured combination. The right choice is what your anatomy needs, which is what assessment decides.
Rarely. Most nasolabial and marionette concerns in the thirties to fifties are managed non-surgically with structural volumisation, energy-based lifting and muscle rebalancing. Advanced laxity does exist, and an honest assessment will say when surgical consultation makes more sense than more filler.
How long structural volumisation is maintained varies with the product, area and individual; muscle-relaxant effects wear off over time; energy-based lifting builds collagen over months with periodic maintenance. Plans are usually staged rather than delivered as one large session.
Yes — that is the core of the anatomy. Restoring midface support reduces the load of tissue folding onto the nasolabial line, and the fold softens from above. It is routinely the single highest-yield step in a lower-face plan.
Serial direct filling of the same crease without structural review. Each syringe seems reasonable; the sum is heaviness. If a fold keeps 'needing' filler every few months, the plan — not the product — deserves re-examination.
A faint nasolabial line is visible in most faces from youth, especially when smiling, and it is normal. It tends to deepen from the thirties onwards as the cheek compartments lose volume and descend, though genetics, facial structure, sun exposure, smoking and weight change shift the timing considerably. What is causing the line in your face matters more than your age.
Not for the nasolabial fold itself. Botulinum toxin relaxes muscle, and the fold is mainly caused by volume loss and descent, so relaxing the muscles around it can flatten the smile and look unnatural. Botulinum toxin does have a role for marionette lines, where relaxing the depressor anguli oris lifts downturned mouth corners, and for a gummy smile, which is a separate concern.
They can. Losing facial fat, particularly quickly, reduces support in the cheek and lets the fold look deeper, which is why significant weight loss sometimes changes the lower face more than people expect. Where weight has changed, the plan accounts for where volume has been lost rather than simply adding filler to the crease.
Rohrich RJ, Pessa JE. The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg 2007;119(7):2219–2227. source
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