Smile lines: what really softens the fold
Smile lines (the nasolabial fold) are rarely a problem of the fold alone. In most faces, the fold deepens because the midface has lost support and volume above it. That is why what most often softens the fold is treating the cause, often starting with the cheekbone area, and only then assessing how much direct product is still needed. Toxin, biostimulators and threads each have specific, limited roles.
Patients arrive with a ready-made question: "will Botox get rid of it?", "will a biostimulator fix it?", "can you put in threads?". This page answers each one directly, so you can explain why the proposed plan is what it is.
Why do smile lines appear?
The nasolabial fold is a natural crease, present even in children when they smile. What bothers people is when it stays marked with the face at rest. The most common causes add up:
- loss of cheekbone projection, with the cheek sinking toward the fold;
- looser retaining ligaments, which let the cheek fat slide down and gather above the crease;
- loss of collagen and skin firmness;
- bone remodeling of the midface with age;
- a very active upper lip musculature, in some cases.
Treatment changes according to the weight of each cause. The layered reading is covered in facial aging by layers.
What does each treatment do for smile lines?
| Treatment | What it can do | What it does not do |
|---|---|---|
| Cheekbone filler | Restore support above the fold, softening it indirectly | Does not treat skin quality |
| Direct filler in the fold | Soften the crease with localized volume | Does not correct the drop of the midface; in excess, it weighs the face down |
| Collagen biostimulator | Improve skin firmness and quality over the months | Does not erase the fold; slow, variable result |
| Thread lift | Slightly reposition the midface and stimulate collagen | Subtle, temporary effect; does not replace surgery |
| Botulinum toxin | In selected cases, reduce the muscular component | Does not replace volume; inappropriate use can alter the smile |
| Surgery | Treat marked sagging and excess skin | Beyond the scope of injectables |
In practice, the plans that work best tend to combine approaches, in stages, rather than relying on a single one.
Does Botox get rid of smile lines?
In general, no. Toxin relaxes muscles; smile lines are usually a volume and support problem. In specific situations, when muscles that lift the upper lip are involved, the professional may consider toxin as a complement, taking care not to lengthen the lip or change the smile. The difference between relaxing the muscle and replacing volume is covered in Botox or hyaluronic acid.
Does a collagen biostimulator get rid of smile lines?
It does not erase the fold. A biostimulator can improve the firmness of the midface tissue over the months and, with that, slightly soften how the fold reads in people with mild to moderate sagging. It is a base treatment, not a spot treatment. Expectations and response time are covered in biostimulator: when do results show.
Can PDO threads be placed for smile lines?
PDO threads with barbs are usually used to slightly reposition the midface, which can soften the fold through traction, while smooth threads act mainly as a collagen stimulus. The effect tends to be subtle and temporary and depends heavily on skin quality and the degree of sagging. The type of thread, the vector and the indication are decisions for the qualified professional, according to the rules of their professional council.
And direct filler, how long does it last?
Filler in the fold with hyaluronic acid generally lasts 6 to 12 months, sometimes a little longer. The area moves a lot when talking and smiling, which tends to shorten how long the filler lasts compared with more static areas, such as the cheekbone. The product, the volume and the metabolism also play a part.
The goal is not to reduce the fold to zero. A softened fold keeps the smile natural; a fold "erased" with too much product usually leaves the upper lip heavy and the face looking artificial. The details of the procedure are in nasolabial fold filler.
How do you assess what the patient really needs?
- Three-quarter view: has the cheekbone lost projection?
- Lift test: when you slightly lift the cheek with your fingers, does the fold improve? If so, the midface support carries weight.
- Skin: is there sagging and loss of firmness that call for a biostimulator?
- Smile: is there a significant muscular component?
- Continuity: does the fold continue into the marionette line and the mouth corners?
- Degree of sagging: marked excess skin is beyond the reach of injectables.
The anatomy, usual volumes and complications of the area are covered in nasolabial fold.
Where does Harmy come in?
In Harmy, the professional can mark the Nasolabial Fold point and the Cheekbone point and set the ml for each one. The projection shows, on the patient's own photo, the difference between treating only the fold and including the midface, which helps explain why the plan starts with the cheekbone. It is an illustrative simulation that changes only what was marked, not a promise of results.
Frequently asked questions
Does Botox get rid of smile lines?
In general, no. Smile lines usually come from loss of support and volume, and botulinum toxin does not replace volume. In specific situations, with a muscular component, the professional may consider it as a complement.
Does a collagen biostimulator get rid of smile lines?
It does not erase the fold, but it can improve the firmness and quality of the midface skin over the months, which sometimes softens how the fold reads. The effect is gradual and varies.
Can PDO threads be placed for smile lines?
Threads may be considered to slightly reposition the midface or to stimulate collagen, with a subtle, temporary effect. The indication, the type of thread and the vector are up to the professional, after an assessment.
How long does filler last in smile lines?
Generally 6 to 12 months, sometimes a little longer, depending on the product, the volume and the movement of the area, which is considerable when talking and smiling.
Harmy images are illustrative simulations generated by AI from the patient's photo to support the conversation between practitioner and patient. They are not a promise of results. Indication, technique, product and volume are solely the decision of the licensed practitioner. This content is for information only and does not replace a clinical assessment.