Why a deepening nasolabial fold is not always a sagging problem, how descent and volume loss are told apart, and why lifting a fold caused by volume loss alone tends to disappoint.
The nasolabial fold — the line running from the side of the nose down toward the corner of the mouth — is one of the most commonly asked-about concerns in a facial consultation, and one of the most frequently mistreated when the underlying cause is assumed rather than examined. A deepening fold is often described as sagging, and a thread lift is often requested as the fix. In a meaningful share of cases, that assumption is only partly right, or not right at all.
This page explains why a nasolabial fold is not always a descent problem, how Edition assesses descent and volume loss together rather than defaulting to one explanation, why lifting a fold that is caused mainly by volume loss tends to disappoint, and what is considered when both mechanisms are present at once.
It does not cover the broader set of situations where a thread lift is not the right choice at all — that general discussion is in When a Thread Lift Is Not the Right Choice. It does not cover combination treatments as a general topic, which is addressed in Combining a Thread Lift, and it does not cover the mouth corners as their own region, discussed separately in Sagging at the Mouth Corners.
A nasolabial fold can deepen because tissue has sagged, because the volume underneath has thinned with age, or because of both at once. A thread lift addresses sagging by repositioning descended tissue; it does not restore volume that has been lost. When volume loss is the dominant cause, lifting the fold alone tends to produce a disappointing result — which is why Edition evaluates both mechanisms before recommending a plan, and says so directly when a thread lift is not the answer.
On this page
- Why a fold is not always a sagging problem
- How descent and volume loss are told apart
- Why lifting a volume-loss fold disappoints
- What is considered when both are present
- Why this distinction is a differentiator, not a technicality
- How the plan is designed
- What to observe before you come in
- A third possibility: the fold that has become a crease
- Why this is the fold most often treated twice
- Questions patients ask
Why a fold is not always a sagging problem
A nasolabial fold exists on almost every face to some degree, because it marks a natural boundary between the mobile cheek and the relatively fixed tissue around the mouth. What changes with age is how deep and how permanent that line becomes, and there are two distinct reasons it can deepen.
The first is sagging — the same mechanism responsible for deep cheek descent and a collapsing jawline. As the mid-face tissue loses its support and moves downward, it can fold and bunch at the nasolabial crease, deepening the line as a byproduct of tissue arriving there from above.
The second is volume loss. The fat pads that once sat under the skin of the cheek and around the fold thin with age, independent of whether any tissue has actually descended. Without that underlying volume, the skin has less support and the crease reads as deeper, even though nothing has moved out of place — there is simply less filling it in from beneath.
Both processes can occur in the same face, at the same time, and to different degrees — which is exactly why a fold that "looks the same" on two different patients can require two entirely different treatments, and why a plan copied from someone else's result is not a reliable way to decide what your own fold needs.
How descent and volume loss are told apart
Edition's consultation for this concern assesses both mechanisms rather than assuming one. The examination looks at whether the surrounding mid-face tissue shows signs of having moved — a flattened or heavier appearance higher up the cheek, a jawline that has lost definition, a general sense that tissue has migrated downward — which would support a descent-driven diagnosis.
At the same time, the examination checks the volume directly beneath and around the fold itself. A face where the cheek has become visibly hollow or flat, independent of any sagging elsewhere, points toward volume loss as the primary or contributing cause. This is a specific point in Edition's assessment: a nasolabial fold is treated as a case where descent and volume loss are evaluated together as standard practice, rather than a case where sagging is assumed by default and volume is considered only if the first attempt disappoints. In many patients, both findings are present together, and the plan is built to address the proportion of each rather than treating the fold as a single, uniform problem.
| Descent-driven fold | Volume-loss fold | |
|---|---|---|
| Surrounding tissue | Mid-face and jawline often show signs of tissue having moved downward | Cheek area may look hollow or flat, without evidence of tissue displacement |
| What is beneath the fold | Displaced tissue that can be repositioned | A thinned fat layer that cannot be repositioned because it is no longer there in sufficient quantity |
| What a thread lift changes | Meaningful — the tissue causing the fold is moved back toward its original position | Limited — there is little displaced tissue for the thread to act on |
| What actually helps | Repositioning via a thread lift, often alongside neighbouring regions | Restoring the underlying volume, considered separately at the consultation |
As with most facial diagnoses, real faces tend to sit somewhere between the two columns rather than cleanly in one. The purpose of the table is not to let a patient self-diagnose from it, but to make clear why an examination looks at more than the fold itself before recommending a plan.
Why lifting a volume-loss fold disappoints
A thread lift works by pulling tissue in a direction and holding it there while collagen forms around the thread. That mechanism only helps when there is tissue to reposition — when the fold has deepened because something moved. Where the fold has deepened mainly because volume has thinned, there is comparatively little displaced tissue for a thread to act on, and lifting an area that has lost its underlying support does not put that support back.
Patients in this situation who are treated with a thread lift alone tend to report a result that looks marginally different but not meaningfully better — the crease may shift slightly, but the hollowness underneath it, which was the actual driver of how deep it looked, remains unaddressed. This is one of the more common sources of disappointment after a thread lift performed on this region without a clear diagnostic separation beforehand.
What is considered when both are present
Where the examination finds both descent and volume loss contributing to the fold, the plan considers a volume-restoring treatment alongside the thread lift, rather than relying on repositioning alone. The specific volume-restoring option is decided at the consultation, based on the degree of hollowness found and how it relates to the rest of the mid-face plan — this page does not set out that comparison in detail, since it is treated as a separate combination decision once the diagnosis is complete.
What matters at this stage is the principle rather than a specific product: a fold with a real volume-loss component needs volume addressed as part of the plan, not substituted by lifting alone, and a fold that is purely descent-driven does not need volume added simply because volume treatments exist as an option.
Why this distinction is a differentiator, not a technicality
It would be simpler, from a sales perspective, to treat every nasolabial fold complaint as a thread lift candidate and let the procedure speak for itself. Edition's approach is the opposite: where the diagnosis does not support lifting as the primary answer, that is what the patient is told, even when it means recommending a different plan or not recommending the procedure they came in asking for.
“It is not that I recommend a thread lift to every patient — what matters is choosing the method best suited to the current state of the face.” — Dr. Dae-hee Han, written interview reply, 15 July 2026
This is not a hedge or a disclaimer. It reflects a specific clinical judgment: that a procedure performed on the wrong diagnosis produces a result that looks like something was done, without producing the change the patient was actually looking for — and that outcome serves no one, including the clinic performing it.
How the plan is designed
The sequence for a nasolabial fold complaint follows Edition's general diagnostic order for facial descent and volume concerns: first separating the causes at play — sagging, volume loss, or both — then assessing how the fold relates to the surrounding mid-face and mouth-corner region, and only then designing a plan that may include thread placement, a volume-restoring option, or a combination of the two.
Because the nasolabial fold sits at the intersection of several regions treated separately elsewhere on this site — the deep cheek above it, the mouth corners beside it — the plan is rarely finalised without considering how those regions interact. A fold treated in complete isolation from its surroundings risks the same kind of disjointed outcome described for jawline-only plans elsewhere on this site.
This is also why a nasolabial fold complaint is one of the more common reasons a first-visit plan changes from what the patient expected when they booked the appointment. A patient who arrives asking specifically for "a thread lift for my smile lines" is, in effect, asking for a tool before the diagnosis has been made — and Edition's practice is to complete the diagnosis first, even when it means the conversation moves away from the specific procedure requested.
What to observe before you come in
The distinction this page turns on can be partly tested at home, and the test is the same one used at examination.
In a mirror, lift the tissue of the cheek gently upward and outward with your fingertips and watch the fold. If it resolves while the tissue is held, displacement is contributing. If it persists, something other than displacement is producing it — most often a shortage of volume beneath.
Check it in two positions as well. Descent behaves differently lying down than sitting up, because gravity is acting differently on displaced tissue. A hollow looks much the same in either.
Neither observation settles the question, and both make the consultation more productive. What is worth avoiding is concluding from them which treatment you want — the weighting between the two causes is what the examination produces, and most faces show some of each.
A third possibility: the fold that has become a crease
Descent and volume loss are the two causes this page is built around, and there is a third finding that belongs alongside them because it is regularly mistaken for both.
Skin that has been folded along the same line for many years does not always return flat when the folding stops. The line becomes established in the skin itself — visible at rest, present in photographs taken with a neutral expression, and unchanged when the face is manipulated. This is not tissue sitting in the wrong place, and it is not an absence of volume beneath. It is a property of the surface.
The reason it matters here is that it does not respond to either of the treatments this page has been separating. Repositioning tissue that is already in position does nothing to a crease. Filling beneath a crease can lift the surrounding surface without altering the line running across it, and in some cases makes the line more conspicuous rather than less by raising what sits on either side of it.
Established creases are assessed as their own finding and answered with treatments aimed at the skin rather than at position or volume. What matters at the diagnostic stage is simply that the possibility is on the table, because a fold that has all three components present — descent above it, volume loss beside it, and a crease along it — is a fold where treating any one alone produces a partial answer and an unsatisfied patient.
Why this is the fold most often treated twice
There is a pattern worth naming, because naming it is most of what prevents it.
When a treatment aimed at a fold produces less than was hoped for, the most common next step is not to reconsider the diagnosis. It is to repeat the same treatment with more of it — more threads, more volume, a stronger version of what was done before — on the assumption that the approach was right and the quantity was wrong.
Sometimes that assumption is correct. Where the cause was identified accurately and the response was simply modest, doing more of the same is a reasonable second step. But where the cause was misidentified at the outset, increasing the dose increases only the mismatch. A volume-loss fold treated with more repositioning becomes a face under more tension with the same hollow in it. A descent-driven fold treated with more filling becomes a heavier face with the tissue still sitting where it was.
The question that separates the two is unglamorous and it should be asked before the second treatment rather than after: did the first treatment change what it was aimed at? If the region it targeted did move, the diagnosis held and the quantity is worth revisiting. If that region did not change, the quantity was never the variable.
Questions patients ask
My nasolabial fold has gotten deeper — does that automatically mean I need a thread lift?
Not automatically. A deepening fold can come from sagging, volume loss, or both, and only sagging is addressed by a thread lift. An examination is needed to determine which is driving your particular fold before recommending a treatment.
How do I know if my fold is caused by volume loss?
A face where the cheek area around the fold looks hollow or flat, independent of any tissue that appears to have descended, is more consistent with volume loss. This is assessed properly during an in-person examination rather than from a description.
What happens if I get a thread lift for a fold that is really about volume loss?
The fold may shift slightly, but the underlying hollowness that made it look deep in the first place is not addressed, and the result tends to look marginal rather than meaningfully improved. This is why the diagnosis is made before recommending the procedure, not after.
Can volume loss and sagging both be treated in the same visit?
Where both are found to be contributing, a plan that addresses both is considered together, rather than treating one and leaving the other for a later visit.
Will I be told if a thread lift is not the right answer for my fold?
Yes. If the examination does not support a thread lift as the primary treatment for what is causing your fold, that is communicated directly, along with the reasoning and the alternative that better matches the diagnosis.
I'm in my late twenties and already have a visible nasolabial fold. Is that unusual?
A visible fold at rest is common at any age and is not, by itself, a sign of either sagging or significant volume loss. In younger patients it is more often related to individual facial structure than to either of the two age-related mechanisms this page describes, which is worth raising directly in a consultation.
If I only have volume loss and no sagging, does that mean I don't need any procedure at all?
It means a thread lift specifically is unlikely to be the right first step. Whether any procedure is worth considering, and which one, depends on how much the volume loss is affecting your appearance and what you are hoping to change — a decision made in consultation, not a default recommendation.
About the author
Dae-hee Han, MD — Board-Certified Plastic Surgeon (specialist certificate No. 2045, issued 3 March 2014; medical licence 00394, issued 26 February 2009). Master's degree, Ajou University School of Medicine. Training at the Craniofacial Center, Chang Gung Memorial Hospital, Taiwan (2013), and the IFAAS Mini Fellowship, University of Florida, USA (2016). Eighteen years in practice since medical licensure in 2009; thirteen years as a board-certified plastic surgeon. He carries out consultation, procedures and follow-up personally; fee guidance is given by the clinic's consultation manager.
Last reviewed: 2026-08-15
Clinic information
Edition Plastic Surgery Clinic & Dermatology
6F, OPUS 407, 407 Gangnam-daero, Seocho-gu, Seoul 06614, Republic of Korea
One minute on foot from Gangnam Station Exit 10
Tel +82-2-591-0100 · editionprs@gmail.com
Consultation hours: Monday to Friday 10:00–19:00 · Saturday 10:00–17:00 · closed Sundays and public holidays
Disclaimer
Individual results may vary. Bleeding, infection, swelling, asymmetry, and scarring can occur. Please decide after a full consultation with a board-certified specialist.
This page is general medical information. It is not a diagnosis, and it does not promise a particular outcome. Surgical and procedure fees are given after an in-person consultation.