Nasolabial Folds and Marionette Lines: How to Improve Their Appearance Without Surgery

You've noticed some lines deepening from your nose toward the corners of your mouth, or creases extending from your mouth toward your chin. You're not alone. Nasolabial folds and marionette lines are a common part of facial aging. In this guide, we'll explore why they develop and what non-surgical options can help.

Nasolabial folds and marionette lines can develop due to midface volume loss, collagen decline, and repeated facial movement. While dermal fillers restore lost volume, collagen-remodeling treatments like Sofwave™ take a different approach by improving the appearance of lines and wrinkles through collagen regeneration.

Nasolabial folds begin beside the nose and travel diagonally toward the corners of the mouth. They are often called smile lines or laugh lines because they become more visible with facial movements such as smiling or laughing.

Marionette lines begin at the corners of the mouth and extend toward the chin. They sit below the mouth and may reflect lower-face changes as well as repeated movement around the lips.

Nasolabial folds and marionette lines have several possible causes, including changes in facial volume, dermal support, repeated movement, and external factors.

Facial fat sits in distinct superficial and deep compartments that can change with age. Research found significant volume loss in both layers of the midface over an average of 11.3 years, with proportionally greater loss in the deep fat compartments. As midface support changes, the transition between the cheek and the area beside the mouth may become more pronounced, making nasolabial folds more visible. 

Weight loss can also affect facial volume. Recent radiographic research in people using GLP-1 receptor agonists found that midface volume loss occurred primarily in the superficial fat compartments, with an average 7% reduction in midfacial volume for every 10 kg of total weight lost. These findings suggest that the pattern of volume change associated with substantial weight loss may differ from age-related facial volume changes.

Collagen provides structural support to the skin, while elastin helps it return to its natural position after movement. As collagen and elastin decline with age, folds that once appeared mainly with facial expressions can become more noticeable even at rest.

Repeated expressions can make established lines more noticeable. Sun exposure contributes to collagen breakdown, and smoking is associated with earlier facial wrinkling. Gravity also acts on tissues whose underlying support has changed over time.

Different non-surgical treatments target different causes of nasolabial folds (also called smile lines or laugh lines) and marionette lines. Some restore lost volume, while others improve the appearance of lines and wrinkles.

Skincare can support hydration and help protect the skin from additional UV-related changes. Topical ingredients such as retinoids, vitamin C, and niacinamide may help address some signs of photoaging, while retinoids such as retinol have evidence for improving the appearance of fine wrinkles. 

However, topical care has limited influence on deeper nasolabial folds or marionette lines and cannot replace lost facial volume. 

Dermal fillers add volume and may be used when volume loss contributes to nasolabial folds or marionette lines. Depending on facial anatomy, a provider may place filler in or around the areas contributing to the fold. Most fillers are temporary, and the appropriate material, amount, and placement vary from individual to individual.

Energy-based treatments work differently from fillers. They deliver controlled energy into selected skin layers to support collagen remodeling and improve the appearance of lines and wrinkles. They do not replace lost facial volume.

Sofwave™ is a non-invasive, needleless ultrasound treatment that is FDA-cleared to improve the appearance of facial fine lines and wrinkles. Sofwave™ stimulates collagen remodeling to improve the appearance of lines and wrinkles. It does not add facial volume. 

Sofwave™ uses Synchronous Ultrasound Parallel Beam Technology (SUPERB™) to deliver controlled ultrasound energy to the mid-dermis at a depth of approximately 1.5 mm, promoting collagen remodeling.

In a 2023 lower-face study, Hongcharu, Boonchoo, and Gold used Antera 3D imaging to measure the depression volume of nasolabial folds and marionette lines after a single Sofwave™ treatment. Mean depression-volume changes were statistically significant at both one and three months compared with baseline, and reductions in nasolabial folds and marionette lines were observed in more than 60% of participants as early as one month. The study did not find a significant additional mean change between the one- and three-month assessments.

More recent research provides additional evidence of dermal remodeling following synchronous parallel ultrasound treatment. A 2025 clinical and histologic study by Suh et al. reported a significant increase in elastic fibers following facial treatment, while a separate 2025 study by Carruthers et al. found continuing collagen and elastin remodeling in human skin biopsies through 10 months after treatment.

Fillers add volume, whereas Sofwave™ improves the appearance of facial lines and wrinkles through collagen remodeling. If both are used, Sofwave™ should be performed first as the base treatment, with fillers administered afterward at a separate appointment. When energy-based devices and hyaluronic acid fillers are combined, applying the energy-based treatment before filler injection is generally recommended to reduce the risk of filler degradation, according to a 2024 paper by Yi. Suitability and timing should be determined by the treating physician based on individual anatomy, medical history, and treatment goals.

Read more about lifting the lower face without surgery.

A Sofwave™ session typically takes 30–45 minutes, and a topical anesthetic may be used for comfort. The treatment is non-invasive and has minimal downtime.

Results develop gradually as collagen remodeling progresses. The Hongcharu study assessed the lower face at one and three months, so individual timelines may vary.

You've now learned how nasolabial folds and marionette lines develop, and which treatment options address them. If you're considering Sofwave™ for your lower face, a qualified provider can determine whether it's right for your anatomy and goals. Find a Sofwave™ provider near you.

Nasolabial folds and marionette lines are a natural part of aging, but they don't have to define how you feel about your appearance. Whether you choose skincare, fillers, Sofwave™, or a combination, understanding what each treatment can and cannot do will help you and a qualified provider build a plan tailored to your anatomy and goals.