Here's something that catches almost everybody out: the crease running between your nostril and the corner of your mouth has been on your face since the day you were born. What the years take is the spring underneath it, so a fold that once vanished the moment you stopped smiling now takes its time about leaving.
Nasolabial fold or marionette line: putting the right name to each
Two lines frame your mouth, one above and one below, and most people have never been told either name.
The upper one begins beside the nostril and finishes at the corner of the mouth. In everyday speech it is your smile line, and plenty of people simply call it the line by the nose. On a clinic menu the very same crease turns into a nasolabial fold. That is two old Latin scraps pushed together, one meaning nose and one meaning lip. Nose, then lip. The long word tells you nothing the short one did not.
The lower one picks up at that same corner and runs on down toward the jaw, and that is a marionette line. You have a pair of them, one each side. The name is worth thirty seconds, because once you have it you'll never mix the two up again. Picture a wooden puppet: its chin is carved as a separate piece so the mouth can open and close, and the join that lets it move runs down from each corner. Your own face has exactly that geography, minus the strings.
Why a line you have had all your life starts to show
So why does a crease you have carried since infancy only start bothering you in your thirties or forties? There is a lovely everyday picture for this, and it explains very nearly the whole of it.
Open out a brand new road map on the kitchen table. Smooth it once with your hand and it stays down obediently. The creases are absolutely there, folded in at the factory, because a map is built to bend along them, but from the other side of the room you would struggle to point at one. Now leave that same map in the glovebox for a few years, opened and folded and opened again over a hundred journeys. Drop it on the table now and it falls straight back into its own creases and stays there. Nobody drew fresh lines on that paper. The paper simply stopped springing back.
That is your face, and it is the honest answer. Your nasolabial crease marks the border between two neighbours that move separately, the cheek on one side of it and the lip on the other, which makes it the hinge your smile turns on. Dig out a photograph of yourself as a small child caught mid-laugh and there it is, as deep as it has ever been, and gone again by the next photograph. For years your skin behaves like new paper: it folds when you are pleased and lies down again once you are finished, because collagen and elastin, the two things that give skin its spring, are still in good supply. Both thin out as the decades pass. Fold a face several hundred times a day without that spring underneath it, and the crease begins to stay behind after the smile has left.
Something else is going on as well, and it happens above the line rather than inside it. What sits high in the cheek gives way by degrees, and whatever it used to carry comes down until the crease underneath catches it. That is far too big a subject to bolt onto this one, so cheek filler has an article of its own.
Marionette lines are the same story told a little lower. The corner of your mouth is about the busiest ground on a human face, creased by every word and every mouthful, and it sits directly underneath everything that is on its way down.
Route one: nasolabial fold filler, and what it actually does
Dermal fillers are soft gels that your body breaks down over time, put in at a chosen depth to replace volume the skin can no longer hold on to. Filler for smile lines and marionette lines is squarely what these gels are made for. The gel used here is Juvéderm®, and it is made of hyaluronic acid, which is nothing exotic: your skin has been making its own since you were born, and simply makes less of it as time goes on.
Here is what happens when it works. A crease shows because the skin along it has nothing holding it out any more, so it settles into its own fold and stays there with no particular reason to leave. Support that fold from below and the skin is carried back out of it, which is why the softening shows up on the day itself and not somewhere down the line: the gel takes the weight the moment it is placed.
One distinction matters more than all the others, because it decides whether filler is even the right tool. Stand at the mirror and let your face go completely slack. A line that is still sitting there while nothing whatsoever is moving is a volume question, and volume is exactly what filler answers. A line that only appears when you talk and laugh is a muscle question, and muscle is what anti-wrinkle injections are for. A great many faces carry some of both, which is perfectly ordinary, and it takes moments to work out in person.
Marionette line filler runs on the same principle, with one thing worth knowing about that particular spot. The corner of your mouth is the most expressive centimetre you own. Once a line sets in below that corner, the corner itself starts to read as though it has turned down, so a perfectly cheerful person keeps being asked whether they're all right. Treating those lines is often less about the line than about handing the corner back its neutral.
Route two: treating the cheek and leaving the line alone
The second route surprises people, because it never goes near the line at all.
Restore the cheek and the fold beneath eases off on its own, with no needle ever visiting the crease. Whether your face wants that, or wants the line worked on where it is, or honestly wants a bit of both, is the real question a consultation exists to answer. And when several areas want attention together rather than one line chased at a time, the 8-point facelift covers eight of them in a single appointment.
The one case where volume makes it worse
Filler puts volume back. It has no way at all of taking slack out, and that is a genuine limit rather than a piece of small print.
When the real trouble lower down is loose skin and not a crease at all, adding volume underneath gives you a heavier face instead of a fresher one. That is a different job wanting different tools, so the menu carries a thread lift, which picks sagging skin back up with dissolvable threads, and skin tightening, which puts the spring back into skin that has lost it. Whether yours is a loose-skin question or a volume one is something you'll be told plainly, and if the truthful answer is that it wants leaving alone for now, you'll be told that instead.
The face we are not trying to give you
Come back to the map for a moment, because it makes this part obvious. Nobody wants a map that cannot fold. The creases are how the thing works, and a map that opens flat and stays flat is not a map any more, it's a poster.
Your face is no different. Those two lines are where it bends when you are delighted, and every good year you have had is pressed into them. Take them out altogether and you have not removed a flaw, you have removed a hinge.
There is a practical half to this as well, and it is the half other people register without ever knowing why. What gives treated faces away is rarely a line you can still see; it is a line that never changes, the same depth whether the person is laughing at something or waiting for a bus. A face that reads as done is usually a face that has stopped moving, and that has never been the aim here.
So here is the measure of good work on these two lines: they go quiet at rest, and they come straight back the moment you are pleased about something.
What the consultation settles first
Everything starts with a conversation, and the first thing that conversation works out is which of the possible causes is actually driving what you see: the crease itself, what has gone from higher up, firmness that has faded, or some mixture of all three. Getting that right is what sets the placement and the quantity. Both change enormously from one face to the next, which is why nothing gets priced before somebody has actually seen your face.
You will hear honestly what would improve things, what would not, and the exact price of your plan before anything begins. Every treatment at our aesthetic clinic in Manchester is delivered by qualified medical professionals at a CQC-registered clinic. An injectable appointment is a quick one, and the downtime afterwards is minimal.
Fillers biodegrade, which simply means your own body takes the gel away over the following months, so the fading is part of the design rather than a fault. The length of that fade is not the same for every face or every gel, which is why the honest answer comes at the consultation.
None of this deserves another year of squinting into the mirror trying to work it out alone. Arrange a consultation and you will leave knowing what is behind your own two lines, which route would suit them, and what it would cost to do properly. Quite often the useful part is finding out that the line you have been staring at is not the thing that needs treating.