Smile Lines by Age: What Changes in Your 20s, 30s, 40s and Beyond
Medical Director Dr Sin Yong explains how smile lines change from the twenties onwards, and what is usually considered at each stage at IN Eternity Clinic.
WhatsApp to Enquire →Key facts ↓Smile lines, or nasolabial folds, are present in everyone. In your 20s they usually show only when you smile; in your 30s skin quality starts to matter; in your 40s cheek volume loss and early laxity deepen them; from your 50s, descent and bone change lead. What is considered follows the layer that has changed, not your age. See nasolabial folds treatment.
- A separate unit: cadaver dissections show the nasolabial fat is a discrete compartment, and facial fat ages compartment by compartment rather than as one mass [1].
- Bone: the upper jaw, including the area beside the nose, is one of the parts of the facial skeleton prone to resorb with age, removing support from the cheek [2].
- Sunscreen: in a randomised trial of 903 adults under 55, daily sunscreen users showed no detectable increase in skin ageing over 4.5 years, and 24% less ageing than those using it at their discretion [3].
- A higher-care area: in a review of 98 cases of vision change after filler, the nasolabial fold was the injection site in about 13 in 100 [4].
Why do smile lines deepen with age?
The nasolabial fold is a boundary between the cheek, which sits on fat pads over the upper jaw, and the firmer tissue around the mouth. Four layers change behind it, each on its own clock. The skin loses collagen, faster with sun. The cheek fat, which sits in separate compartments, deflates and slides down and forward; the nasolabial fat is a compartment of its own [1]. The ligaments that hold the cheek loosen. And the bone of the upper jaw beside the nose gradually recedes [2].
Most people have a mix of these, in different proportions, which is why two people of the same age can have very different folds. In Singapore, year-round sun speeds up collagen loss in skin types III to V, and many people have a fuller, flatter midface whose descent shows early as a fold rather than as hollowing.
What usually changes in your 20s, 30s, 40s and 50s+?
The table below sets out common patterns. It is a guide, not a timetable: a 35-year-old with heavy sun damage and a 50-year-old with good skin can need very different things.
| Stage | What usually changes | Usually considered | Usually not needed |
|---|---|---|---|
| 20s | A fold seen mainly when smiling; strong smile muscles or a full cheek | Often nothing; daily sunscreen; acne treated early | Filler in the fold |
| 30s | Creases start to stay at rest; skin loses some bounce | Skin boosters such as Profhilo, Rejuran or Juvelook; sunscreen; a retinoid at home | Large volumes |
| 40s | Midface fat deflates; the fold is visible at rest; early laxity | Small amounts of cheek filler or CaHA along the bone; collagen stimulators; energy-based tightening | Fold filler on its own |
| 50s and beyond | Descent, early jowls, receding bone; collagen loss speeds up after menopause | A combined plan: lifting, threads, cheek support; a surgical opinion where laxity is marked | Repeated filler to chase the fold |
What helps smile lines in your 20s and 30s?
At this stage the fold is mostly expression and skin. A fold seen only when smiling, over good skin, may need nothing at all, and there is no reason to start a treatment simply because of age. Daily broad-spectrum sunscreen has good evidence behind it: in a randomised trial, adults who used it daily showed no detectable increase in skin ageing over four and a half years [3].
When creasing starts to stay in the thirties, the skin itself is usually the target. Skin boosters improve hydration and thickness, so the fold reads as a softer line; a retinoid at home supports this. Filler placed directly in the fold is rarely needed this early, and adding small amounts year after year is how a heavy lower face builds up.
What is considered in your 40s, 50s and later?
From the forties, volume and support usually lead. The fold is treated from above: supporting the cheek with small amounts of filler, or a collagen stimulator such as Radiesse, along the bone often softens the fold more than filler placed in the line, and a little fold filler is added at review only if a groove remains. Where the cheek has slid down rather than emptied, lifting addresses the cause: the VF Lift – Vertical Facelift on Volnewmer, HIFU, Ultherapy or threads, chosen with care in lean faces, where heat can hollow.
The area beside the nose sits over the facial artery, so it needs care: in a review of 98 cases of vision change after filler, about 13 in 100 followed injection of the nasolabial fold [4]. Injections are given by a doctor, and hyaluronidase is kept on site. If you have had filler here before and it now looks heavier, an ultrasound scan comes before any more product. Where loose skin and jowls are marked, a surgical opinion may be the more honest recommendation.
What Dr Sin Yong looks for
- The fold at rest and when smiling, which separates expression from structure.
- Cheek volume and position: flattened, descended, or both.
- Skin quality and sun damage over the fold.
- Any previous filler, checked by ultrasound before more is added.
- Face shape and leanness, which change whether heat-based lifting suits you.
General clinical observations used at consultation; they describe what is checked, not any individual result.
Frequently asked questions
At what age do smile lines appear?
Everyone has a nasolabial fold from youth. It usually shows only when smiling in the twenties, starts to stay at rest in the thirties or forties, and deepens later as cheek fat, ligaments and bone change. The timing varies widely between people.
Should I get filler for smile lines in my 20s?
Usually not. A fold seen only when smiling is mostly expression and natural cheek fullness. Sunscreen and good skin care are the main steps, and filler in the fold this early tends to add weight over the years.
Can sunscreen prevent smile lines?
Sunscreen cannot stop the fat and bone changes behind the fold, but it slows skin ageing. In a randomised trial, daily sunscreen users showed no detectable increase in skin ageing over 4.5 years.
Why do smile lines get deeper in your 40s?
The fat compartments of the midface deflate and slide down, the ligaments holding them loosen and the skin thins, so cheek tissue piles up against the fold. Bone beside the nose also recedes with age.
Is filler in smile lines safe?
It is a higher-care area because the facial artery runs close by. Careful technique, small amounts, injection by a doctor and hyaluronidase on site reduce risk. Pain, blanching or a dusky patch after filler is an emergency.
Can smile lines be treated without filler?
Often, yes. Skin boosters improve the skin over the fold, and lifting with energy-based treatment or threads addresses a cheek that has descended. Which suits you depends on the cause found at assessment.
Book an assessment
IN Eternity Clinic, 9 Scotts Road, #12-01 Pacific Plaza, Singapore 228210. By appointment with Medical Director Dr Sin Yong. Monday to Saturday, 11am to 8pm. WhatsApp or call +65 8815 3008. At IN Eternity Clinic a consultation fee applies, and it is waived if you go ahead with any medical treatment; the fee is S$120.
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References
- Rohrich RJ, Pessa JE. The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg 2007;119(7):2219-2227. doi:10.1097/01.prs.0000265403.66886.54
- Mendelson B, Wong CH. Changes in the facial skeleton with aging: implications and clinical applications in facial rejuvenation. Aesthetic Plast Surg 2012;36(4):753-760. doi:10.1007/s00266-012-9904-3
- Hughes MCB, Williams GM, Baker P, Green AC. Sunscreen and prevention of skin aging: a randomized trial. Ann Intern Med 2013;158(11):781-790. doi:10.7326/0003-4819-158-11-201306040-00002
- Beleznay K, Carruthers JD, Humphrey S, Jones D. Avoiding and treating blindness from fillers: a review of the world literature. Dermatol Surg 2015;41(10):1097-1117. doi:10.1097/DSS.0000000000000486
These sources describe mechanisms and general evidence. They are not a promise of any individual result; suitability is decided at an in-person assessment.