Laugh lines, or nasolabial folds, run from the corner of the nose to the corner of the mouth. Everyone has them, including children, because they mark where the cheek meets the upper lip and that boundary exists regardless of age. What changes is depth, and the reason they deepen has very little to do with laughing.
Sam Assassa, MD is a member of the American Society of Aesthetics and Mesotherapy and has taught injectable technique to physicians in more than 15 countries. He founded Beverly Hills Aesthetics in 1995 and is board certified in Internal Medicine.
Why Smile Lines Deepen
The fold is a boundary, and it deepens when the tissue on either side of it changes.
Cheek fat deflates and descends. The fat pads of the midface shrink and slide downward, and as they descend they pile against the fold, making it deeper from above.
Bone support diminishes. The facial skeleton resorbs, so the tissue has less structure holding it in position.
Skin loses elasticity. The fold creases more readily and recovers less well.
Repeated movement. Smiling and speaking fold the same crease thousands of times, which eventually etches it into the skin itself.
The first two matter most, and they are why the fold is a midface problem presenting at the mouth.
Why Filling the Fold Often Disappoints
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The instinct is to fill the crease directly, and it does soften it. But if the fold exists because the cheek above it has deflated and descended, filling the crease treats the symptom while the cause continues. The face gets fuller around the mouth and the fold returns, and repeated treatment that way is how the heavy lower face look develops.
Restoring the cheek lifts the tissue and softens the fold from its origin. Patients are frequently surprised that treating an area they had not complained about resolved the one they had.
Direct filling still has a role, generally as a refinement after the midface has been addressed rather than as the first move.
Laugh Lines Versus Marionette Lines
These are adjacent and get confused. Laugh lines run from nose to mouth corner. Marionette lines run from the mouth corner down toward the jaw. Different anatomy, different muscles involved, and different treatment, though they frequently appear together as the lower face descends.
How Laugh Lines Are Treated
- Cheek treatment, restoring midface volume so the tissue lifts off the fold. Usually the first step.
- Dermal filler placed in the fold itself, as refinement once the cause has been addressed.
- Vector lifting where descent across the midface is the dominant factor.
- Resurfacing where the fold has etched into the skin as a fine line within the crease.
Let Us Evaluate Your Midface Aging in Beverly Hills
Dr. Assassa will assess whether your folds are a fold problem or a cheek problem, which determines where treatment should actually go. Request a consultation or schedule your appointment online.