When patients ask me about the best treatment for smile lines, I first determine what is creating the line. Smile lines, often called laugh lines or nasolabial folds, extend from the sides of the nose toward the corners of the mouth. A deeper fold may develop because the cheek has lost volume and support. Fine wrinkles in the same area can come from collagen loss, sun damage, smoking, and years of facial movement. These problems may look similar in the mirror, but I do not treat them the same way. A nasolabial fold filler may help a deeper structural fold, while Fraxel or CO2 laser resurfacing may be better suited to wrinkles etched into the skin.
This distinction is the most useful place to start when researching smile lines treatment. Filling every visible crease can make a face look heavy. Resurfacing a fold caused mainly by volume loss may also give disappointing results. I look at cheek support, skin thickness, facial movement, fold depth, and surface texture before recommending a treatment. The goal is not to remove normal facial anatomy. It is to soften changes that bother you while keeping your expressions natural.
What Are Smile Lines and Nasolabial Folds?
Nasolabial folds are normal creases between the nose and mouth. They are visible in many young people when they smile, so having them does not mean your face is aging prematurely. They tend to become more noticeable at rest as facial structure changes with age. The cheeks lose some volume, supporting tissues shift, and the skin produces less collagen and elastin.
Smile lines should also be distinguished from wrinkles immediately around the lips. Fine vertical lip lines are often called perioral lines. Marionette lines begin near the corners of the mouth and extend toward the chin. All three concerns can appear in the lower face, but each has different anatomy and may need a different treatment plan.
Why Do Smile Lines Become Deeper?
Aging is one reason nasolabial folds become more pronounced, but it is not the only factor. Genetics influence facial shape, cheek projection, skin thickness, and how early a fold becomes visible. Long-term ultraviolet exposure damages collagen and elastic fibers. Smoking can accelerate skin aging. Major changes in body weight can also change facial volume and make an existing crease more apparent.
The factors I commonly evaluate include:
- Age-related loss of cheek and midface volume
- Changes in collagen and skin elasticity
- Genetic facial structure and natural fold depth
- Long-term sun exposure and photoaging
- Smoking and other sources of premature skin aging
- Significant weight loss or repeated weight changes
Facial expression contributes to how the area moves, but smiling itself is not something I tell patients to avoid. A natural smile is part of normal facial movement. Treatment should respect that movement rather than trying to eliminate it.
What Do Current Cosmetic Procedure Statistics Show?
Injectables and resurfacing treatments remain common in the United States. The latest American Society of Plastic Surgeons report available in 2026 covers procedures performed in 2024. ASPS estimated 5,331,426 hyaluronic acid filler procedures, 9,883,711 neuromodulator injections, and 3,703,305 skin resurfacing procedures during that year. These figures describe broad cosmetic procedure categories. They are not statistics for smile-line treatment alone.
| 2024 U.S. procedure category | ASPS estimate | How the category can relate to smile lines |
|---|---|---|
| Hyaluronic acid fillers | 5,331,426 | May restore volume or soften selected facial folds |
| Neuromodulator injections | 9,883,711 | Reduce muscle activity in selected expression wrinkles |
| Skin resurfacing | 3,703,305 | Includes procedures used for wrinkles, texture, and photoaged skin |
The numbers are useful because they show how frequently these treatment categories are performed. They do not tell us which option belongs in one person’s face. Anatomy still determines the choice.
Dermal Fillers for Smile Lines and Nasolabial Folds
For a fold related mainly to lost volume or support, dermal fillers for smile lines are often one of the treatments I discuss. Hyaluronic acid filler can soften the transition between the cheek and lower face. Sometimes I place filler directly within a nasolabial fold. In another patient, restoring support higher in the cheek can improve the fold without placing as much material inside the crease itself.
The U.S. Food and Drug Administration recognizes approved dermal filler uses for moderate-to-severe facial wrinkles and folds, including nasolabial folds. The FDA also notes that results depend on the underlying tissue, the type of filler, the amount placed, and the treatment location. This is one reason there is no single filler for nasolabial folds that is best for everyone.
Restylane Defyne for Deeper Laugh Lines
Restylane Defyne is a hyaluronic acid filler approved for moderate-to-severe deep facial wrinkles and folds, including nasolabial folds. FDA patient labeling states that improvement in laugh lines can last up to 12 months. Individual results vary, and some patients will metabolize filler faster than others.
Different Restylane and Juvéderm products also have different textures and lifting properties. When someone asks me to choose a smile line filler, I consider the depth of the fold, nearby cheek volume, skin thickness, facial proportions, and how the area moves. I do not choose a product based on brand recognition alone.
When Sculptra May Fit Broader Facial Volume Loss
Sculptra behaves differently from a conventional hyaluronic acid filler. It contains poly-L-lactic acid and stimulates collagen production gradually. I may discuss Sculptra when nasolabial folds appear together with more generalized facial volume loss. In that situation, treating only the crease may not address the larger change in facial structure.
Sculptra results develop over time rather than appearing immediately. Galderma reports that results from approved cheek treatments can last up to two years. That does not mean every nasolabial fold needs Sculptra. I consider it when gradual collagen stimulation and broader facial support fit the patient’s anatomy and goals.
Fraxel and CO2 Laser for Wrinkles Near Smile Lines
Filler cannot repair every wrinkle around the mouth. When the concern is fine, crepey, sun-damaged, or etched skin, a laser treatment for smile lines may address part of the problem that filler cannot. Lasers work on skin quality and collagen remodeling. They do not replace missing facial volume.
| Treatment | Often considered for | Timing of improvement | General recovery pattern |
|---|---|---|---|
| Hyaluronic acid filler | Volume-related nasolabial folds | Visible immediately, followed by settling | Temporary swelling, tenderness, or bruising can occur |
| Sculptra | Broader facial volume and collagen loss | Gradual change over weeks to months | Temporary swelling, redness, tenderness, or bruising can occur |
| Fraxel | Fine wrinkles, texture changes, and sun damage | Progressive as the skin remodels | Redness, swelling, and peeling vary by treatment settings |
| Fractional CO2 laser | Deeper etched wrinkles and significant photoaging | Progressive as healing and collagen remodeling occur | More recovery than non-ablative fractional resurfacing |
I was involved in the development and early clinical research of Fraxel technology. Fraxel for smile lines can be useful when fine wrinkles and sun-related skin changes accompany the fold. Fractional treatment creates microscopic zones within the skin while leaving areas between those zones untreated. This allows collagen remodeling to occur over time.
For more deeply etched wrinkles around the mouth, I may consider CO2 laser for smile lines. Fractional CO2 resurfacing is more aggressive than non-ablative Fraxel treatment. It can address deeper wrinkles and damaged surface skin, but recovery is also greater. Treatment settings, skin type, wrinkle depth, and a patient’s tolerance for downtime all matter when choosing between these approaches.
Does Botox Treat Smile Lines?
Botox for smile lines is a common search, but true nasolabial folds are usually not primarily a neuromodulator problem. Botox, Xeomin, and Dysport work by reducing selected muscle activity. They are well suited to many expression-related wrinkles, such as crow’s feet, frown lines, and selected forehead lines. Those wrinkles have a different cause from a structural nasolabial fold.
Neuromodulators can have selected uses around the mouth, but placement requires particular care because the muscles in this region control smiling and lip movement. Injecting the wrong muscle or using too much product can affect facial expression. A gummy smile is also a separate concern. It involves excessive gum display when smiling and should not be confused with nasolabial folds simply because both are noticeable during facial expression.
What Are the Risks of Nasolabial Fold Filler?
Common reactions after filler include swelling, bruising, redness, tenderness, and temporary discomfort. Less common problems include infection, nodules, inflammation, and other delayed reactions. The most serious filler complication is accidental injection into a blood vessel. The FDA reports that vascular injection can lead to tissue death, vision abnormalities including blindness, and stroke. These events are uncommon, but they are serious.
Seek immediate medical attention after filler if you develop unusual or severe pain, sudden vision changes, stroke-like symptoms, or skin that becomes white, gray, or blue near the treated area. Filler injection requires detailed knowledge of facial anatomy and blood vessels. It should be approached as a medical procedure rather than a routine beauty treatment.
How I Choose a Treatment for Smile Lines
When patients ask me how to get rid of smile lines, I first decide whether I am looking at a structural fold, a surface wrinkle, or a combination of both. A deeper volume-related nasolabial fold may respond to filler. More generalized facial volume loss may lead to a discussion about Sculptra. Fine surface wrinkles and sun damage may point toward Fraxel. Deeply etched perioral wrinkles may be better suited to fractional CO2 resurfacing. Neuromodulators have a more limited role when the main concern is a true nasolabial fold.
My approach reflects more than 20 years of work in cosmetic and laser dermatology. I graduated from Harvard College and NYU School of Medicine and completed fellowship training in laser and dermatologic surgery. I am a double board-certified dermatologist and micrographic dermatologic surgeon and serve as an Associate Clinical Professor of Dermatology at Mount Sinai. I have also trained physicians for Allergan, Galderma, and Merz. You can read more about my training and research here.
Getting a Clear Diagnosis Before Treating Smile Lines
The most useful question is not which product is newest or which procedure is most popular. It is what is causing your particular line. Nasolabial folds caused by facial structure do not behave like fine sun-damaged wrinkles. Treating them as if they were identical can lead to unnecessary procedures or unnatural-looking correction.
If you are researching smile line treatment NYC or nasolabial fold filler NYC, use an evaluation to understand the anatomy first. I see patients at our Manhattan and Garden City offices and can assess whether the concern comes mainly from volume, skin texture, facial movement, or a combination of these factors. Patients who want an individual assessment can book an appointment with our office.
