Dr Scott J Turner | Specialist Plastic Surgeon (FRACS) | Sydney
Patients ask me about nasolabial folds more often than almost any other facial feature. Most have already tried filler, sometimes multiple rounds. The fold softens for a while, the filler wears off, the fold comes back, and the conversation eventually shifts to whether surgery would do something different. The honest answer: yes, sometimes, and the reason depends on what’s actually causing the fold. Folds aren’t a single problem. They’re the visible result of several anatomical changes happening together, and matching the right treatment to the right cause is the part most online content misses. Whether the right answer involves filler, facelift surgery, or a combined approach, the choice should follow anatomy rather than marketing.
This guide explains what a deep plane facelift can and can’t do for nasolabial folds, when filler is the better option, how the deep plane technique compares to a SMAS facelift for fold softening, and which patients tend to see meaningful change. As a Specialist Plastic Surgeon (FRACS) practising from clinics in Bondi Junction and Manly, I have this conversation almost every consultation week. If you’re already considering surgery, the deep plane facelift page covers the surgical detail and consultation process.
In short: A deep plane facelift may soften nasolabial folds in suitable patients by releasing retaining ligaments and repositioning descended midface tissues rather than just tightening skin. It usually softens the fold rather than removing it completely, because fold depth is influenced by midface descent, volume loss, bone support, skin quality, and a structural crease component that surgery cannot fully erase. Whether it’s the right answer depends on which factor is dominant in your case.
Why Nasolabial Folds Deepen with Age
A nasolabial fold isn’t really a wrinkle. It’s an anatomical landmark where the cheek tissue meets the upper lip area, present in almost everyone from a young age. What changes with time isn’t whether you have a fold. It’s how prominent it becomes.
Three things drive the change.
First, the cheek tissue above the fold descends. Facial retaining ligaments, which anchor soft tissue to deeper structures, gradually loosen. The cheek fat pads shift downward and forward, piling up against the relatively fixed nasolabial crease. This added weight above the fold is what makes the crease look deeper.
Second, volume loss compounds the effect. Soft-tissue thinning, fat deflation in the midface, and even subtle changes in the underlying bone reduce the upper-cheek support that previously held tissue away from the fold. Less support above means more accumulation along the fold line.
Third, the crease itself has a structural component. The nasolabial crease is anatomically a fixed feature anchored by deep tissue attachments. That’s why even significant tissue repositioning rarely makes the fold disappear entirely. It’s also why filler placed directly into the fold often produces a heavier or more projected appearance rather than a smoother result. The fold has a foundation that injection alone cannot relocate.
How a Deep Plane Facelift Can Soften the Fold
The mechanism matters here. It explains why the technique can produce a different outcome than skin-tightening alone.
A deep plane facelift dissects beneath the SMAS (the deeper fibromuscular layer of the face), enters the safe anatomical plane below it, and releases the retaining ligaments that have tethered descended cheek tissue. Once those ligaments are released, the surgeon can mobilise the deeper composite tissue and reposition it vertically, restoring cheek volume to a position closer to where it sat earlier in life. The skin redrapes over the repositioned structure rather than being pulled tight on its own.
For nasolabial folds, the relevant effect is the cheek mass moving back up and away from the fold. With less tissue weight piled against the crease, the fold often looks softer at rest, even though the crease itself hasn’t been directly treated. A 2023 study in Plastic and Reconstructive Surgery reported that a modified deep-plane technique combining deep fat compartment mobilisation with adjacent muscle work produced better wrinkle severity scores than the authors’ earlier deep-plane approach, which suggests fold improvement depends on the exact technical detail rather than the label “deep plane” alone.
The result is structural rather than superficial. That’s why the change tends to look more natural than aggressive skin tightening. And why it can hold up better over time when the patient’s anatomy is suited to the approach.
Why a Deep Plane Facelift Doesn’t Always “Erase” Nasolabial Folds
This is the part online content tends to skip past, and the part most worth understanding before committing to surgery.
The fold has multiple contributors. Repositioning descended tissue addresses one of them. Just one. The structural crease anatomy, the volume loss, the skin quality, and the underlying bone support are not addressed by a facelift alone. Patients whose folds are mainly caused by midface descent tend to see meaningful softening. Patients whose folds are mainly caused by volume loss, thin skin, or a strong fixed crease often see less dramatic change, even with technically excellent surgery.
A 2025 critical review of 78 deep-plane procedures reported some recurrence of nasolabial fold appearance between 6 and 12 months in the cases studied, and concluded that deep-plane facelift isn’t suitable for every face type. That isn’t an argument against the procedure. It’s an argument for honest assessment before surgery: which component of the fold is dominant, and which procedure (or combination) is most likely to address it.
The realistic framing is “softening” rather than “erasing.” Patients who arrive expecting their nasolabial folds to disappear after a facelift are often disappointed, even when the surgery itself produces a good result. For a fuller picture of the trade-offs, the risks and complications after facelift surgery blog covers what to factor into the decision.
Considering deep plane facelift surgery? The deep plane facelift surgery page covers the surgical detail and consultation steps. To arrange an assessment in Bondi Junction or Manly, contact the practice.
Filler vs Deep Plane Facelift for Nasolabial Folds
This comparison comes up most often. The answer depends on the cause.
Filler can help when volume loss is the dominant factor and the fold is otherwise mild. By restoring volume in the upper cheek, filler can reduce the contrast between the fullness above the fold and the fold itself, softening its appearance. It works less well when the fold is associated with significant cheek descent, because adding volume to descended tissue often makes the heaviness above the fold more visible rather than less.
A deep plane facelift addresses the descent. By repositioning the deeper tissue back up where it sat previously, the procedure changes the structural relationship between the cheek and the fold rather than camouflaging the fold from the outside. For patients with cheek descent, jowls, and broader lower-face laxity, this is generally a more durable answer than repeated filler rounds.
The two approaches also combine in some cases. Facial fat transfer at the time of facelift, restoring lost volume in the temples, cheekbones, or under the eyes, can address the volume loss component alongside the structural repositioning. The right plan depends on what the assessment shows, not on which treatment was the patient’s starting assumption.
Not sure whether filler, surgery, or both is right for you? The right approach depends on which component of your nasolabial fold is dominant. To discuss whether a deep plane facelift, fat transfer, or non-surgical management is appropriate, book a consultation at the Bondi Junction or Manly clinic.
Deep Plane vs SMAS Facelift for Nasolabial Folds
The SMAS facelift is the more traditional approach. It works on the SMAS layer itself, tightening or repositioning it without dissecting beneath it, which means the deeper retaining ligaments stay intact. This is a reliable, well-understood operation that produces good results for many patients. For nasolabial folds specifically, however, the SMAS approach has a structural limitation: with the ligaments still anchoring the cheek tissue, the amount of midface elevation achievable is more limited than what a deep plane technique can produce.
The deep plane approach goes below the SMAS, releases the ligaments, and mobilises the deeper composite tissue. The cheek mass moves more freely. For folds that are primarily driven by cheek descent and ligament laxity, this generally produces more meaningful fold softening than a SMAS technique would.
That said, both approaches have a role. Patient anatomy, skin quality, the degree of midface descent, neck involvement, previous surgery, and surgeon experience all factor into which technique is most appropriate. A deep plane facelift isn’t categorically “better” than a SMAS facelift, and patients who arrive convinced they need one specific technique sometimes need a different conversation. For more on the technical comparison, see the difference between deep plane and traditional facelifts blog.
Who Is Most Likely to See Improvement?
Suitability assessment is individual, but certain patient profiles tend to align with meaningful nasolabial fold improvement after a deep plane facelift.
Patients with visible midface descent, cheek heaviness, and jowls tend to benefit because the underlying problem (descent) matches what the procedure addresses. The fold softens because the tissue weight above it is repositioned, not because the crease itself has been treated directly.
Patients whose folds are mainly volume-loss driven, who have thin skin, a strong fixed crease anatomy, or significant bony changes in the maxilla often see less dramatic fold change. For these patients, fat transfer, fillers, skin treatments, or a different surgical plan may be more relevant. Surgery in this group can still be appropriate for other reasons (jowl correction, neck contour, overall facial proportion), but the fold-specific change may be modest.
The honest framing I use at consultation is that nasolabial folds sit at the intersection of anatomy, tissue descent, volume, and skin quality. The right plan depends on which is dominant. The fold is a symptom. The cause varies.
Is a Deep Plane Facelift Right for You?
For selected patients with cheek descent, jowls, and broader midface laxity contributing to deeper nasolabial folds, a deep plane facelift may produce meaningful softening. For patients whose folds are mainly volume-driven or anatomically structural, surgery may help less and other approaches may suit better. The trade-off is that this is real surgery, with scars, healing time, and risks that need to be understood before deciding.
At consultation, the productive questions to work through are these: which component of the fold is dominant in my case (descent, volume loss, skin quality, structural crease)? What degree of change would be realistic? Would adjuncts like fat transfer, eyelid surgery, or skin resurfacing be considered for overall facial balance? What are the specific risks and recovery expectations for my situation?
Current Medical Board and AHPRA requirements for cosmetic surgery in Australia include the following: a referral, preferably from the patient’s usual GP, or if that is not possible from another independent GP or specialist medical practitioner; a minimum of two pre-operative consultations, with at least one in person with the operating surgeon; a cooling-off period of at least seven days after the two consultations and informed consent before surgery can be booked or a deposit paid; and psychological screening for suitability. Where screening raises concerns, referral for independent evaluation may be required before surgery proceeds.
If you’d like to discuss whether a deep plane facelift is appropriate for your nasolabial fold concerns and overall facial structure, I consult from clinics in Bondi Junction and Manly. The deep plane facelift surgery page has more detail, or contact the practice.
Frequently Asked Questions
1. Does a deep plane facelift get rid of nasolabial folds?
Not entirely. The procedure may soften nasolabial folds in suitable patients, but it doesn’t remove them completely because fold depth is affected by midface descent, volume loss, bone support, skin quality, and a fixed crease anatomy. Surgery addresses the descent component, repositioning the deeper cheek tissue back up and away from the fold. The fold itself usually still exists after surgery, just in a softer form. Patients with cheek heaviness and jowls tend to see the most fold change. Patients whose folds are mainly volume-loss driven often see less dramatic improvement.
2. Why do nasolabial folds improve after a deep plane facelift?
Because the procedure releases the retaining ligaments that anchor descended cheek tissue, and repositions the deeper composite tissue vertically rather than just tightening the skin. With the cheek mass moved back up where it sat previously, there’s less tissue weight piled against the fold, and the crease appears softer at rest. The skin then redrapes naturally over the repositioned structure. This is structural improvement rather than skin-tension improvement, which is why the result tends to look more natural and hold up better when the patient’s anatomy is suited to the approach.
3. Is filler better than facelift for nasolabial folds?
It depends on what’s causing the fold. Filler can help when volume loss is the dominant factor and the fold is otherwise mild, by restoring upper-cheek volume and reducing the contrast above and below the crease. It works less well when significant cheek descent is present, because adding volume to descended tissue can make the heaviness above the fold more visible rather than softening it. A deep plane facelift is more relevant for folds associated with cheek descent, jowls, and broader laxity. Some patients benefit from a combination approach, with fat transfer addressing volume loss alongside surgical repositioning.
4. Can a SMAS facelift improve nasolabial folds?
A SMAS facelift can improve some lower-face ageing and may produce modest fold softening in selected patients. The structural limitation is that a standard SMAS technique works on the SMAS layer itself without dissecting beneath it, which means the deeper retaining ligaments remain intact and the amount of midface elevation achievable is more limited. A deep plane technique generally produces more meaningful fold softening for descent-driven folds because it releases those ligaments and mobilises the deeper tissue. Both approaches have a role; the choice depends on individual anatomy, ageing pattern, and goals.
5. Who is a good candidate if nasolabial folds are the main concern?
A better candidate is usually someone whose folds are part of broader midface descent, cheek heaviness, jowling, or overall facial laxity rather than an isolated crease caused mainly by volume loss or skin quality. The procedure works on the cheek descent component of fold prominence, so patients with that pattern tend to see meaningful change. Patients whose folds are predominantly volume-driven, who have thin skin, or who have a strongly anchored fixed crease often need different or additional approaches. Suitability is assessed individually at consultation, looking at the dominant cause rather than the fold alone.
