When smile lines start to look deeper, the crease itself often isn’t the real issue. More often, the cheeks have dropped and lost volume, creating a bigger step between the cheek and the fold. Here’s how we pinpoint the cause first, then choose an approach that suits your face.
Hello from DAYONE Clinic. Maybe you’ve noticed it in the mirror: smile lines that never used to stand out suddenly look sharp and defined. The line lingers even when your face is at rest, and in photos the area around your mouth can look heavy and weighed down.
It’s tempting to assume the fold itself needs filling. But when we examine faces in consultation, we often find the fold looks deeper because the cheek above it has changed in position and volume. The face is built in layers—skin, the fat beneath it, fascia, supporting ligaments and bone—that together form one connected structure. So a change in one area usually goes hand in hand with changes in the tissue around it.
Why do sagging cheeks make smile lines look deeper?
Nasolabial folds, often called smile lines or laugh lines, run from the sides of the nose to the corners of the mouth. They’re a natural crease that forms when you smile or talk. Even young faces have them to some degree, but once the midface starts to change, the same line can look much deeper.
The midface spans the area from under the eyes to around the mouth, including the cheekbones and cheeks, and it shapes much of your overall look. When volume here stays where it belongs, the skin around the mouth below it is naturally supported.
With age, though, the ligaments and fascia that hold up the cheeks lose elasticity, and cheek fat can shift or change in amount. Cheek volume may then slide downward or diminish. When that descended tissue piles up along the edge of the fold, the difference in height above and below the line grows, and the fold casts a darker shadow—so the same crease looks deeper. Think of it this way: the line itself hasn’t so much deepened as the volume above it has moved down, making the step more pronounced.
Meanwhile, the area where the cheek used to sit can look comparatively empty. You may notice hollowing below the cheekbones or flattening under the eyes, and the whole face can look tired and heavy. That’s why we often hear, “I’ve lost weight, but I actually look older.”
Several factors are at work. As collagen and elastic fibers in the skin decline, creases may not smooth out as easily, and sun exposure, dryness and repeated facial expressions can also play a role. At a deeper level, changes in the bone structure of the cheekbones and upper jaw reduce the support beneath the tissue, so the same amount of tissue can look saggier.
For some people the main factor is loss of skin elasticity, for others it’s volume loss or sagging tissue, and for many it’s a combination. That’s why deep-looking smile lines can’t be pinned on a single cause. Age matters, too: people in their 30s and 40s often notice early loss of firmness and shifting volume, with facial contours that start to look less defined. People in their 50s, 60s, 70s and beyond more often describe their whole face as dropping, as sagging cheeks lead to changes around the mouth and jawline.
What do our doctors look for in a smile line consultation?
The first question isn’t which treatment works for smile lines. It’s what’s changing in your face to make them look deeper. That’s why, at DAYONE Clinic, we assess your face and skin as they are now before settling on any treatment.
We don’t focus on the folds alone. We evaluate the whole face—cheek position and volume, support beneath the cheekbones, skin elasticity, and changes around the mouth and jawline. We compare your face at rest and in motion, watch how the folds and cheeks change when the face is gently lifted upward, and check how pronounced the step looks from the front and in profile. Together, these help us gauge where the changes started.
We also talk through what bothers you most, how much change you’re hoping for, and how much change would look natural on your face. What you want and what suits your face aren’t always the same, so the plan often shifts during this conversation. Two people with the same smile line concern may need very different things: one may need volume restored, another may need elasticity and sagging addressed first, and another may need the mouth area and jawline treated together to rebalance the whole face.
Which options might be considered?
Once the cause is clear, several approaches are possible depending on your face. If the main issues are reduced skin elasticity and early sagging, for example, laser lifting to help maintain firmness may be an option. If the cheeks have sagged more noticeably, a thread lift to reposition the sagging tissue may be worth considering.
If volume loss has weakened support in the midface, restoring volume where it’s needed—with filler, for example—may be appropriate. If overall skin quality has declined, a skin booster can be considered as a complementary option. Still, none of these is a one-size-fits-all answer; they’re options to select and combine based on your face.
For some people, filling the fold directly is the right call. For others, the folds look naturally softer once the cheek position has been addressed first. Lifting sagging cheeks too aggressively, or filling the folds heavily all at once, can also make expressions look unnatural. The midface moves a lot when you smile and talk, so what looks good at rest doesn’t always look natural in motion.
For people in their 50s through 70s and beyond, a subtle refinement that preserves their current look leads to lasting satisfaction; for those in their 20s through 40s, it’s a more defined change that suits their own face. That’s why finding the amount you actually need right now matters more than the amount or intensity of treatment.
In the end, it’s about what your face needs
Treating smile lines is less a one-and-done procedure than a process of assessing results and refining along the way. Right after treatment, swelling and tissue reactions make it hard to judge the final result. So once some time has passed, a follow-up is needed to check whether the intended change has come through naturally, whether anything looks off when you make expressions, and whether any area needs refining. At DAYONE Clinic, we see everything from the first consultation through treatment, touch-ups and maintenance as one continuous process.
The bottom line
Smile lines that look deeper can reflect several intertwined factors: changes in midface volume, sagging cheeks, reduced skin elasticity and loosening of the supporting structures. At DAYONE Clinic, our guiding philosophy is “Your own face—softer and more youthful,” and we work with you to find both the change you need now and the change that suits your face. If your smile lines bother you, we recommend a consultation to assess your face as it is now—including cheek position, volume and skin elasticity—before deciding what to do about the folds themselves.
This article is general information about the treatment and does not replace an individual diagnosis or treatment plan. Results and their duration vary from person to person.
Wondering what would suit you?
Whether a treatment suits you, and how to plan it, is best decided with a doctor.