Nasiolabial smile lines - Alternatives to fillers? (photo)

Ordinarily, I would consider the use of an HA filler for the treatment of smile lines. This would usually be a robust HA volumizing filler when cheek volume deficit is at the root of the smile line development or direct injection of a low viscosity, cohesive, malleable HA filler directly along the fold when there is little cheek volume deficit to account for the smile lines.
However, through the years, I have used subcision, without any additional filler at all, to elevate and smooth smile lines.
I would be reluctant to suggest treatments, such as peels or microneedling, which are best reserved for superficial, surface textural irregularities. And I would suggest a healthy dose of buyer beware when being hawked, as you no doubt will be, expensive, supposedly "next big thing" light and energy-based gizmos, such as fraxel lasers or RF devices, as the hard science to support their use lags well behind the heavy marketing hype and social media buzz to hawk them.
You would be wise to consult with a board certified cosmetic dermatologist with extensive experience in performing subcisions. Hope this helps and best of luck.

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Topicals are usually just a waste of money when it comes to deeper NL grooves. Implants which are permanent or fillers which are temperary are the only really choices you have to make a significant improvement.

There are several alternatives to fillers that can help improve the appearance of nasolabial smile lines. Here are some options you might consider:

Topical Treatments: Look for skincare products containing retinoids, hyaluronic acid, or peptides. These ingredients can help improve skin texture and stimulate collagen production over time.

Laser Treatments: Fractional laser resurfacing can help stimulate collagen production and improve skin elasticity, reducing the appearance of smile lines.

Microneedling: This procedure involves creating tiny punctures in the skin to stimulate collagen production, which can help reduce the appearance of fine lines and wrinkles.

Chemical Peels: A series of chemical peels can enhance skin texture and tone, helping to minimize the appearance of nasolabial folds.

Radiofrequency Treatments: These treatments use energy to heat the skin, stimulating collagen and tightening the skin, which can help reduce wrinkles.

Facial Exercises: Some people find that specific facial exercises can help strengthen the muscles around the mouth and reduce the appearance of smile lines.

Lifestyle Changes: Keeping your skin well-hydrated, using sunscreen daily, maintaining a healthy diet, and avoiding smoking can also help prevent further deepening of lines.

Before deciding on a treatment, it’s a good idea to consult with a dermatologist or skincare specialist to determine the best option for your skin type and concerns.

You may want to look into Morpheus8. This treatment combines RF technology with microneedling to improve overall skin tone and texture. We also recommend using medical grade skin care products like Transform MD and wearing sunscreen every day. I've included a video I hope you find helpful.

Nasolabial folds (smile lines) are a very common concern, and while dermal fillers are the most well-known solution, there are alternatives but would require patience :)
Collagen Biostimulators (Sculptra or Radiesse) – Unlike traditional fillers, these gradually build your own collagen for long-term skin improvement and softening of lines.
PDO Threads – A great option for lifting the midface and reducing the appearance of smile lines by repositioning sagging skin and stimulating collagen.
RF Microneedling (Sylfirm X) – This tightens the skin and improves elasticity, making nasolabial folds appear less prominent over time. Would need a few sessions
PRF EZ Gel Injections – Platelet-rich fibrin (PRF) is a natural, regenerative treatment that enhances collagen production and improves skin quality without adding artificial volume.