The nasolabial fold is one of the most common wrinkles on the face, often associated with an expression of fatigue or severity. Present in all individuals, it tends to deepen gradually with age, due to skin aging, volume loss, and muscular dynamics. Many patients wonder about the ideal time to intervene : should one wait until the fold is very visible ? Can preventive action be taken ? Is there a recommended age from which the treatment becomes relevant ?
There is no universal answer, as this decision does not really depend on age but rather on a precise assessment of the morphology, anatomy, facial dynamics, and aesthetic goals of each patient. The treatment of the nasolabial fold is part of a comprehensive harmonization approach, which takes into account the progressive aging of the tissues and the patient’s personal expectations.
The nasolabial fold is located between the cheek and the upper lip, marking the transition between the malar area (the cheekbones) and the perioral region. It is both a static and dynamic fold, which deepens due to the combined effect of several factors : the sagging of the fat compartments in the midface, the loss of dermal density related to intrinsic aging, the repeated contraction of the upper lip elevator muscles, bone resorption in the upper jaw, and ligamentous and cutaneous laxity.
While the nasolabial fold can appear as an expression line from childhood, it becomes a true marker of aging over the years. At this stage, it reflects a lasting structural change. Its treatment should therefore aim to restore lost volumes, provide support to sagging tissues, and soften the transition between different facial areas.
There is no universal age, but in practice, the first treatment of the nasolabial fold is generally considered between 35 and 45 years, depending on the patient’s morphology, skin quality, and lifestyle habits. Before 35, pronounced folds are rare, except in particular cases : very thin face, hereditary fold, significant weight loss, excessive sun exposure, or premature skin aging.
The appearance of the nasolabial fold does not depend solely on age. It is often an indirect consequence of malar ptosis – the descent of the cheekbones – and progressive volume loss. Thus, rather than focusing solely on the fold itself, the doctor must analyze the face as a whole and determine whether restoring volume to the cheeks or temples would be a more coherent and lasting approach.
An increasing number of patients, often from their thirties, consult for the appearance of the nasolabial fold. It remains subtle but becomes noticeable in raking light or in certain photographs. At this early stage, the goal is not to correct an established wrinkle, but rather to act preventively to preserve volume harmony and avoid a progressive disruption of the skin planes.
This approach is based on injections of small amounts of lightly cross-linked hyaluronic acid, chosen for its suppleness and hydrating properties, to which a Skinbooster may be added. The objective is not to fill the fold or alter the facial structure, but to maintain dermal thickness, stimulate collagen production, and slow the onset of the first signs of aging.
This type of treatment requires great precision. Excessive correction could weigh down the face or freeze its expression. That is why this preventive approach should be entrusted to an experienced doctor, capable of performing the procedure accurately and respecting the natural morphology of each patient.
It is within this age range that treatment of the nasolabial fold becomes most frequently indicated. The fold becomes more noticeable, sometimes even at rest, and the face begins to lose some firmness. At this stage, a targeted and measured correction can restore a refreshed appearance while respecting the natural expression of the face.
The procedure generally involves the injection of moderately cross-linked hyaluronic acid with good cohesiveness. The technique used varies according to needs : linear retro-tracing injection with a cannula, or micro-bolus injection, depending on the depth of the fold. If a loss of projection in the cheeks is observed, a discreet restoration of the midface can also be proposed to enhance overall facial harmony.
After fifty, the nasolabial fold most often reflects a global loosening of the facial structures. In this context, an isolated injection directly into the fold risks weighing down the area without addressing the true cause of the deepening. A more structural approach is therefore required, starting with the restoration of bony and fat support points using medical lifting techniques, before considering a targeted treatment of the fold in a second stage.
In these patients, injections are often spread over several sessions. This stepwise progression allows the face to adapt gradually and ensures a more balanced, natural, and harmonious result.
Regardless of age, it is during the initial medical consultation that the therapeutic decision will be made. It should include : a three-dimensional analysis of the face, an assessment of the patient’s expectations (prevention, rejuvenation, harmonization), a study of facial mobility, and the presentation of different therapeutic options, with their indications, contraindications, duration of effect, and costs.
The doctor must also clearly inform the patient that treatment of the nasolabial fold does not necessarily mean complete disappearance of the fold, but rather a harmonious attenuation, respectful of facial movements.
The notion of the biological age of the face is increasingly valued. It is based on a comprehensive assessment of the face (skin, volumes, tone, symmetry, expression) and allows for the establishment of a personalized treatment plan that does not depend on chronological age.
A 34-year-old patient may show facial laxity equivalent to that of a 45-year-old patient, due to particular genetics, a demanding lifestyle, or associated conditions (hormonal disorders, oxidative stress). Conversely, some people maintain a perfectly toned and minimally marked face up to 50 years.
It is therefore the biological age — not the patient’s actual age — that guides the appropriate timing for the treatment of nasolabial folds.
The age at which treatment of the nasolabial fold becomes relevant also varies according to the patient’s sex. In women, compared to men, the skin is generally thinner and the bone structure smaller, which means the nasolabial fold can appear as early as the thirties. In addition, hormonal variations related to the menstrual cycle, pregnancy, or menopause directly influence dermal collagen quality.
In men, the dermis is thicker, the facial skeleton more voluminous, and the subcutaneous tissues denser. Folds therefore often appear later, but can become deep quickly when aging accelerates (around 45-50 years). Treatment indications must be adapted to skin type, lifestyle, and aesthetic expectations specific to each sex.
Treating nasolabial folds at an early stage, sometimes as early as twenty-eight or thirty years old, can be justified in certain situations. However, an overly hasty intervention or one performed without a genuine indication is not without risks. It can lead to localized overfilling if the volumes chosen do not correspond to the anatomy of an otherwise young face, or to an unesthetic rigidity if the gel used is too cross-linked for still supple and elastic skin. In some cases, the injection may also alter the natural dynamics of the face by hindering facial expressions, or promote psychological dependence in very young patients particularly attentive to their appearance.
In this context, the role of the doctor is decisive. It is their responsibility to refuse unnecessary injections, reassure the patient by directing them toward more appropriate care such as skin treatments, preventive measures, or lifestyle and dietary advice, and only propose an injection when the indication is genuinely justified.
According to a retrospective review published in Journal of Cosmetic and Laser Therapy (2020), the average age for the first hyaluronic acid injection in the nasolabial fold is 41.6 years for women and 46.3 years for men. The study also shows that 22 % of patients start before 35, 47 % between 36 and 45, and 31 % after 46.
These figures confirm that the aesthetic need is most often felt between 35 and 45 years, but there is a growing proportion of younger patients motivated by a preventive approach. Other studies, notably those published in Aesthetic Plastic Surgery, highlight an earlier demand in urban populations exposed to social image pressure, with injections being requested from the early thirties.
Article written by Dr Romano Valeria
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