Thank you for your question.
You submitted your question without a photo.
And you stated in your question that you had fillers done and you’re going to have a
facelift.
And the question is whether you should’ve done the fillers later or whether the fillers
will be affected or taken out by the facelift.
Well, in the absence of more details, I can just basically give you some general concepts
I think are helpful to you in understanding what the impact of the facelift is on fillers
depending on where they’re located as well as what roles fillers have especially in the
context of what a facelift does.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
Face lifting surgery and the use of injectable fillers is a routine part of my practice focusing
a lot on facial aging and helping my patients get optimal solutions based on the treatment
plans that make sense for their situation.
So when it comes to face lifting surgery, the principal goal of a facelift is essentially
to lift sagging tissue which means bringing up of the cheek area, improve the jawline
definition, improve the neck angle or neck definition.
Now we understand very well that facial aging is not just sagging but it’s also volume
loss.
And volume loss is accentuated or emphasized in the bone structure so bone loss is a very
important part of volume loss which is one of the reasons why I explain to my patients
is that you can be someone in their 60s and 70s and no matter how good your facelift performed,
you’re not going to look like somebody in their 20s and 30s.
Now in terms of what’s going to happen to the fillers, well fillers are placed at different
levels and for different reasons.
So when you think of the area where the skin is lifted during a facelift, if you had fillers
in those areas, they can certainly be impacted not necessarily directly by the facelift but
also indirectly.
Swelling, fluid, healing can of course affect the effect of those fillers.
Places such as the dermis or the actual skin itself where fillers are often placed will
not necessarily be impacted especially the areas that would be elevated in the flap of
a facelift.
Usually this means placement around the eyes, placement in the under eye area, the lip area.
So it just really depends on where those fillers are placed.
It’s also important I think to understand that beyond the face lifting procedure, regardless
of the technique, the technique can be anything from a minimal short scar facelift to a more
extensive face and neck lift with platysmaplasty and more extensive skin removal and dissection.
But in the end, what you are doing is you’re restoring the position of the tissue.
What I explain to my patients is once everything is healed, you can decide whether or not you
want to address areas where there’s still going to be volume loss.
Typically, this includes the area in the mid face which is the cheek area as well as in
the chin and even the jaw angle.
Patients come to me who have had facelifts done elsewhere and they’ll say to me, “You
know, I think the doctor should have tightened me more because I still feel like I don’t
see what I want to see.”
And I explain to them that the skin has a certain amount of elasticity and that elasticity
will always equilibrate which means that even if the doctor does it as tight as appropriate
and I think that most very competent and facelift surgeons will of course do that, then a certain
amount of stretch will always occur.
Why?
Because the skin has a certain amount of elasticity that is age-related as well as normal movement
whether you turn your head, look up and look down, the skin will stretch.
But the volume loss at the bone level is an area where there’s opportunity.
So for example we do something called Structural Volumizing.
And in Structural Volumizing, we actually place the volume at the bone level.
And so by putting it at the bone level, between the bone and the muscle, it could be argued
academically that the filler would less likely to be affected.
We can even do some certain hybrid procedures where you do a limited facelift and you can
place volume at the same time.
That’s less common in my practice.
Actually what I do more commonly is combine placement of filler in the cheek area with
eyelid surgery.
So there is a lot of finesse and a matter of what kind of outcome we are interested
in achieving.
But as far as the destiny of the fillers that are already placed, I think it’s less likely
that it’s relevant because the purpose of the facelift is very different from the goal
of the placement of injectable fillers.
And there is a harmony that can be achieved between these two strategies.
So I wouldn't say that what you did prior is actually going to be wasted but understand
that beyond the facelift, there will also probably be an opportunity especially in areas
which the facelift doesn't address to also still do fillers for the purposes to optimize
your appearance.
So I hope that was helpful, I wish you the best of luck and thank you for your question.