There is no single “best” treatment for nasolabial folds because there is no single cause of them. The appropriate approach depends on whether the appearance is primarily related to superficial skin creasing, facial movement, changes in underlying bone, mid-face changes, nasolabial fat, or a combination of factors.

A nasolabial fold may be a superficial crease in the skin caused largely by facial movement, a shadow related to changes in the bone around the base of the nose, or a fold created by changes in the mid face and nasolabial fat. Often, more than one of these factors is present at the same time.

This is why I don’t believe the visible line should automatically be treated simply because it is there.

The first step is understanding why that particular nasolabial fold is present, and whether treatment is appropriate at all.

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What are nasolabial folds?

Nasolabial folds are the natural lines that run from the sides of the nose towards the corners of the mouth.

They are a normal part of facial anatomy and facial expression. They become more visible when we smile, laugh and talk, because the skin and underlying tissues naturally move and fold.

In fact, nasolabial folds aren’t something that only appear with ageing. Even babies have them.

What changes with age is the appearance and prominence of these folds.

This distinction is important because the goal shouldn’t necessarily be to completely eliminate a nasolabial fold. In many people, trying to make the area completely smooth can produce a result that looks less natural, particularly when the person smiles or talks.

For most patients, the more appropriate goal is to soften the appearance of the fold while maintaining natural facial movement and expression.

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Why do nasolabial folds become more prominent with age?

There isn’t one anatomical change responsible for every nasolabial fold.

As the face ages, changes can occur in the skin, fat compartments and underlying bone. These changes can alter the support and contours of the mid face and make an existing nasolabial fold appear deeper or more noticeable.

Changes in the mid-face

The mid-face provides important structural support to the tissues above and around the nasolabial region.

With ageing, there can be changes in the volume and position of the facial fat compartments, as well as changes to the underlying facial bones.

When the mid face loses some of its structural support, the skin and soft tissues can appear to “sink” and descend.

This can make the area around the nasolabial fold appear more pronounced.

Volume loss assessments for the mid-face form part of the nasolabial fold consultation.

Changes in the nasolabial fat

An interesting aspect of facial ageing is that not all facial fat simply depletes.

Some research has demonstrated that the nasolabial fat compartment can actually increase in size with age, while also changing position.

This is important because it challenges the common idea that every facial fold is simply caused by a lack of volume.

The appearance of the nasolabial fold can be influenced by the relationship between neighbouring structures. If the mid-cheek loses support and becomes more recessed, the nasolabial fat can appear increasingly prominent next to it.

The result can be a more noticeable fold or transition between the cheek and upper lip.

This is one reason why treating only the visible line doesn’t always address the underlying cause.

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How I assess the nasolabial folds

When assessing a patient, I don’t simply look at how deep the fold appears.

I look at what the fold actually looks like and where the prominence is coming from.

There are several patterns I commonly consider.

1. A superficial crease in the skin

Some people have a relatively fine crease that is etched into the skin.

This can be particularly noticeable when they smile or animate.

In these cases, facial movement and muscle activity may be contributing significantly to the appearance of the crease.

This is quite different from a deep shadow created by a loss of underlying structural support.

Approaches to support the skin quality and assist in collagen production for superficial creases may be discussed, including wrinkle-reduction and Rejuran options.

2. Shadowing beside the nose

Another presentation is a deeper-looking shadow or groove next to the nostril.

In some patients, this appearance can be associated with changes in the underlying bone around the nasal opening, including resorption around the piriform aperture.

This can create a shadow that makes the nasolabial region appear deeper even when the skin itself isn’t necessarily the main problem.

Shadowing next to the nose is the only ‘volume loss‘ that occurs in the nasolabial fold.

Aesthetic ultrasound may be used in volume loss consultations to identify individual anatomy of the nasolabial fold.

3. Folding of the nasolabial skin

Some patients have more prominent nasolabial tissue and a visible fold where the skin sits over this area.

Changes in the nasolabial fat, combined with loss or repositioning of mid-face fat and changes in underlying bone support, can contribute to this appearance.

These different presentations can look superficially similar in a photograph, but they don’t necessarily have the same underlying cause.

And sometimes, a patient has two or more contributing factors at the same time.

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Why I don’t automatically treat the nasolabial fold itself

One of the most common misconceptions I see is:

“I can see a line, so the line must be where the problem is.”

Facial ageing doesn’t work quite that simply.

A visible line can be the result of changes occurring somewhere else.

For example, imagine a patient who has lost support through the mid-face. Changes in the facial fat compartments and underlying bone can alter the contour of the cheek. The resulting change in support can make the nasolabial region appear more prominent.

In that situation, simply focusing on the line may not be the most appropriate way to approach the concern.

This is why I assess the whole mid face and surrounding anatomy, rather than looking at the nasolabial fold in isolation.

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Your age isn’t necessarily an indication of how deep your folds should be

Age is certainly relevant to facial ageing, but chronological age doesn’t tell me everything I need to know.

I’ve seen patients in their early thirties with quite prominent nasolabial folds, while some patients around 50 have relatively subtle folds.

Genetics, facial anatomy, bone structure, fat distribution, facial movement and changes in weight can all influence how prominent a person’s nasolabial folds appear.

For a younger patient who appears to have experienced a noticeable loss of facial volume, weight loss may also be a contributing factor.

A significant change in body weight can alter facial volume and therefore change the appearance of the nasolabial region, even when someone isn’t experiencing the same age-related changes as an older patient.

I also consider dental position and bite position in some patients, as they may be relevant to the facial structure and appearance.

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Static and dynamic assessment are both important

A person’s face isn’t static.

We smile, laugh, talk and express emotion throughout the day.

For this reason, I don’t assess nasolabial folds only when a patient is sitting completely still.

I look at the face at rest and during movement.

A fold that appears noticeable when someone is smiling may be completely normal facial movement. Trying to eliminate that movement-related fold entirely could create an unusual or unnatural appearance when the person is animated.

This is particularly important when patients are comparing themselves with photographs they have seen online.

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Why social media can create unrealistic expectations

One of the problems with treating facial folds today is that people are constantly exposed to images of faces that don’t necessarily represent real-life anatomy.

Filters, retouching and carefully selected photographs can make it appear as though completely smooth skin is the normal expectation.

It isn’t.

A real face has folds, creases, shadows and movement.

The nasolabial fold naturally becomes more pronounced when we smile, laugh and talk. Expecting it to remain completely flat throughout all facial expressions isn’t necessarily a realistic or desirable outcome.

I often tell patients that the goal is to soften, not eliminate.

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Why treating a nasolabial fold may not be appropriate

Some people come to a consultation concerned about what I would consider a normal amount of fine creasing or shadowing.

In these situations, treatment isn’t necessarily the answer.

If I believe that attempting to completely remove a normal anatomical feature is likely to result in an unnatural appearance, I will explain that to the patient.

There are also situations where a patient’s expectations aren’t realistic enough for me to recommend treatment.

I would rather tell someone that I don’t think treatment is appropriate than perform a treatment simply because they have requested it.

In some circumstances, a patient may also be better suited to an alternative treatment approach or another practitioner, and I may recommend that they seek a different opinion.

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Why over-treating the area can look unnatural

One of the potential problems with trying to completely flatten the nasolabial region is that the natural transition between the cheek and upper lip can be lost.

If the area becomes excessively full, the cheek can appear to blend into the upper lip region, producing what I sometimes describe to patients as a “chipmunk” appearance.

The face can look smoother while simultaneously looking less natural.

This is why I don’t believe that “more treatment” automatically means a better result.

Chasing perfection can sometimes take us further away from what looks natural.

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So, what is the best treatment for nasolabial folds?

The answer is:

The best treatment is the treatment that addresses the underlying cause of the particular nasolabial fold, if treatment is appropriate at all.

For one person, facial movement and superficial skin creasing may be an important contributor.

While another persons nasolabial fold appearance may be influenced by structural changes around the piriform aperture.

And another person may have changes in the mid-face, including changes in cheek fat volume and position, nasolabial fat prominence and underlying bone support.

And for many people, there will be a combination of factors.

This means that there isn’t a universal treatment that can be labelled the “best treatment for nasolabial folds”.

It also means that treatment doesn’t necessarily need to be directed into the visible fold itself.

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Why a consultation is important

A proper assessment allows me to determine what is contributing to the appearance of the nasolabial region, whether treatment is likely to produce a meaningful improvement, and whether the patient’s expectations are realistic.

I assess the fold at rest and during facial movement, consider the surrounding anatomy and look at how different areas of the face relate to one another.

I also consider factors such as age, genetics, facial structure, changes in weight, mid-face volume and, where relevant, dental position.

The treatment plan should come after this assessment, not before it.

This is particularly important when someone arrives at a consultation already convinced that they need a specific treatment because they have seen it recommended online.

The treatment that is appropriate for someone else’s nasolabial folds isn’t necessarily the treatment that is appropriate for yours.

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The bottom line

Nasolabial folds are a normal part of facial anatomy.

They don’t need to be completely removed, and in many cases, attempting to do so can create an unnatural appearance.

The most important question isn’t simply:

“How do I get rid of my nasolabial folds?”

It is:

“Why are my nasolabial folds prominent?”

Once the underlying anatomy and contributing factors have been identified, it becomes possible to determine whether treatment is appropriate and, if so, what approach may be suitable.

For me, this is the most important part of treating any facial ageing concern:

Technique should follow diagnosis, not the other way around.

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Frequently Asked Questions

There is no single best treatment for neck wrinkles and sagging neck skin. The most appropriate approach depends on whether the main concern is horizontal neck lines, crepey skin, true skin laxity, or platysmal bands, as these concerns have different underlying causes.

Non-surgical treatments may address skin quality, hydration, texture, collagen support and the appearance of some wrinkles, but they cannot remove significant excess skin or reproduce a surgical lift. A personalised assessment is therefore important to determine what is actually causing the concern and what level of improvement is realistically achievable.

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The three most common neck concerns I see

When someone tells me they don’t like the appearance of their neck, I first try to understand exactly what they are seeing.

There are three concerns I see particularly often:

• Horizontal neck lines, sometimes called necklace lines or “tech neck”
• Crepey or sagging neck skin
• Platysmal bands, vertical bands created by the platysma muscle

These concerns can occur independently, but they can also occur together.

The difference matters because treating skin texture won’t necessarily correct muscle bands, and trying to improve genuine excess skin with a treatment designed primarily to improve skin quality is unlikely to produce the result someone may be hoping for.

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1. Horizontal neck lines

Horizontal neck lines are static, etched-in lines that run across the front of the neck. They are often referred to as “necklace lines”, or “tech neck”.

Are all horizontal neck lines caused by “tech neck”?

Looking down repeatedly at a phone, laptop or computer can contribute to the formation or worsening of horizontal neck lines. If you spend many hours with your head positioned downwards, the neck repeatedly folds in the same place.

However, not all horizontal neck lines are caused by looking down at a computer or phone.

Genetics, skin structure, sun exposure, skin quality and individual anatomy can all play a role. Some people will develop prominent horizontal lines much earlier than others, even when they don’t have significant skin laxity.

I have seen patients who are relatively young, have good overall skin quality and no obvious signs of general skin laxity, yet have prominent horizontal neck lines.

One patient said she could remember having these lines since her teenage years.

Can horizontal neck wrinkles be completely removed?

This is where I think realistic expectations are particularly important.

Once horizontal lines have been deeply etched into the skin over many years, they will not generally completely disappear.

Depending on the individual and the cause, treatments aimed at improving skin quality may soften the appearance of lines, but complete removal is often unrealistic.

Our goal should not be to make the neck look as though it has never moved or aged. The aim is to improve what is realistically achievable for that person’s skin.

What can help?

Different approaches may be considered depending on the individual, including treatments that support collagen production and skin quality, energy-based approaches and appropriate home skincare.

For example, Rejuran is one treatment where skin quality is part of the concern. Rejuran is a polynucleotide treatment designed to support collagen and elastin production and improve aspects of skin quality, hydration and texture. Suitability and treatment planning are individual. You can read more about Rejuran treatments on our Rejuran page.

Rejuran and other collagen-stimulating approaches are generally not “one treatment and done” treatments. They are often designed as a course of treatments, with improvements developing over time rather than appearing immediately after one session.

Home care is also important.

A simple starting point for many people is to stop treating the neck as though it is a completely separate part of the body and extend appropriate facial skincare down onto the neck.

This may include:

• an antioxidant such as vitamin C
• vitamin A/retinoid products where appropriate
• moisturiser
• daily broad-spectrum sunscreen

However, skincare is individual. Some people can become irritated by vitamin A or vitamin C, and vitamin A products are not appropriate during pregnancy or breastfeeding. The thin skin of the neck can also be more sensitive than facial skin, so products should be introduced appropriately for the individual.

If looking down for long periods is contributing to your lines, simple behavioural changes can also help. Adjust your computer screen so that you aren’t constantly looking down, and be conscious of your head and neck position when using your phone.

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2. Crepey and sagging neck skin

“Loose skin” is often used to describe any neck that doesn’t look completely smooth, but there is an important difference between crepey skin texture and genuine skin laxity.

Someone can have crepey skin without having significant laxity.

Crepey skin may be related to changes in the surface and quality of the skin, including sun damage. It can appear thin, with fine a lined and wrinkled texture, even when the underlying skin still has reasonable elasticity.

This is different from someone who has genuine loss of skin elasticity and excess skin.

How do I assess neck skin laxity?

This is something I assess by looking and by touch.

Mild skin laxity can sometimes be visible as thin, loose skin, particularly around the upper neck underneath the jawline. It can become more apparent from a side profile or when someone turns their head.

I also use clinical observation of skin turgor (how the skin returns after it has been gently pinched).

If the skin returns quickly or “snaps back”, this suggests better elasticity. If the skin remains where it was pinched and returns more slowly, or not at all, there may be reduced elasticity and loss of the skin’s ability to recoil.

This is only one part of an overall assessment, but it helps distinguish different types of skin concerns.

Why does this distinction matter?

Because crepey skin and significant excess skin aren’t the same problem.

If the primary concern is skin texture, improving skin quality, hydration and collagen support may be relevant.

If there is significant excess or lax skin, however, non-surgical skin treatments cannot replicate what surgery does.

Non-surgical treatments can support collagen production, hydration, skin texture and the appearance of fine lines. They cannot remove excess skin or surgically reposition tissue.

This is why I think it is important to be honest about what a treatment can realistically achieve.

If someone has significant laxity and is looking for a dramatic lifting effect, I may explain that I don’t believe the treatments available to me will produce the result they are hoping for. Some people are still happy with a more subtle improvement and others decide that the expected difference isn’t enough to make treatment worthwhile.

There is nothing wrong with either decision.

You can learn more about approaches to skin quality and hydration with a Skin Hydration Consultation.

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3. Platysmal bands

Platysmal bands are different again.

The platysma is a broad, sheet-like muscle that extends through the neck. When it contracts, vertical bands can become visible.

In younger people, these bands are often not particularly noticeable at rest. They may become visible when the platysma contracts. For example, when making certain facial expressions.

As we get older, platysmal bands can become more prominent and may be visible even when the neck is at rest.

This is important because platysmal bands are a muscle-related concern, not simply loose skin.

Someone may look at their neck and think, “My skin is sagging,” when part of what they are actually seeing is muscle banding.

The appropriate approach therefore depends on what is creating the appearance.

If you are concerned about neck bands or movement-related wrinkles, a Wrinkle Reduction Consultation allows the movement and skin to be assessed rather than assuming that every visible line is caused by lax skin.

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Why there isn’t one “best” neck wrinkle treatment.

This is probably the most important thing I would want someone to understand before searching for a treatment.

There isn’t one best treatment for neck ageing.

A person may have:

• deep horizontal neck lines
• crepey skin
• mild skin laxity
• platysmal bands
• sun damage
• changes in the submental area
• or a combination of several of these.

The treatment plan needs to reflect the underlying cause.

For example, if someone has a surface skin-quality concern, the approach may focus on improving the skin itself.

If someone has significant laxity, the conversation is different.

If the concern is primarily muscle-related, that is different again.

And if changes in the chin, jawline or surrounding facial structure are contributing to how the neck looks, the neck shouldn’t necessarily be assessed in isolation. Changes in facial volume and structure can influence the appearance of the lower face and neck. A Volume Loss Consultation can be useful when volume or structural changes are part of the concern.

This is why I prefer an assessment-led approach rather than recommending a particular treatment before seeing someone.

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Do neck treatments need to be repeated?

Often, yes.

One of the misconceptions I hear is:

“I had one treatment and didn’t see a difference, so it didn’t work.”

Some collagen-stimulating and skin-quality treatments are designed to be performed as a course rather than a single session. The biological changes also take time.

If a treatment plan involves multiple sessions, completing only the first treatment may not give you a fair indication of the eventual result.

This doesn’t mean everyone needs a particular number of treatments. The appropriate plan depends on the individual, the treatment being considered and the concern being addressed.

But it is important to understand the difference between a treatment designed to create an immediate visible change and one that works gradually by supporting changes within the skin.

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Can skincare help with neck wrinkles?

One of the simplest things people can do is also one of the things I see neglected most often:

Take your skincare down to your neck.

Many people concentrate on their face, but stop their skincare at the jawline.

The neck is exposed to the same environment as the face, including ultraviolet radiation, yet it is often overlooked when sunscreen and other skincare products are applied.

As a general starting point, appropriate sunscreen every day is one of the most important habits for protecting the skin from further photo damage.

Other products, such as antioxidants, moisturisers and vitamin A products, may have a role depending on the individual. However, neck skin can be sensitive, so introducing active skincare isn’t necessarily as simple as using everything you use on your face.

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What I think people get wrong about treating the neck.

After more than 12 years working in aesthetic medicine, there are three misconceptions I hear repeatedly.

1. One treatment should fix everything

Neck ageing can have multiple causes, so expecting one treatment to address every concern is unrealistic.

Sometimes a combination of approaches is required because there is more than one contributing factor.

2. Non-surgical treatments can produce a surgical result

They can’t.

If you pull loose skin up underneath your jaw and say, “That’s the result I want,” it is important to understand that a non-surgical skin treatment cannot simply reproduce that result.

Non-surgical treatments can improve aspects of skin quality, texture, hydration and collagen support. They do not remove excess skin or surgically reposition tissue.

3. Deep wrinkles should disappear completely

A deeply etched horizontal neck line that has been present for many years may soften with appropriate care, but expecting it to disappear completely is often unrealistic.

We also need to accept that we cannot remain completely wrinkle-free as we age.

Even with excellent skincare and appropriate aesthetic treatments, skin continues to age.

The goal isn’t to look 20 forever. It is to make the most of the skin you have now and maintain it as well as possible over time.

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What are the best treatments for neck wrinkles and sagging skin?

The answer depends on which neck concern you have and how significant it is.

Horizontal lines, crepey skin, laxity and platysmal bands are all different concerns, so they shouldn’t automatically be treated in the same way.

My approach is to first assess the neck and identify the contributing factors. From there, appropriate options can be discussed based on your anatomy, skin quality, goals and expectations.

Sometimes, several treatment modalities are appropriate.

And sometimes, if the degree of laxity or excess skin is significant, I will be honest and say that I don’t believe the non-surgical options I can offer will make enough difference to achieve the result someone wants.

I think that is an important part of ethical aesthetic practice.

The best treatment isn’t necessarily the most intensive treatment. It is the treatment, or combination of approaches, that makes sense for the actual cause of your concern and the result you can realistically achieve.

If you are concerned about neck lines, wrinkles, skin texture, laxity or platysmal bands, a personalised Neck Consultation can help determine what is contributing to the appearance of your neck and what options may be appropriate for you.

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Frequently Asked Questions