What should I do: get a facelift, fillers, or both?

Patients ask me this question all the time. While there’s no pat answer, because each patient’s case is different, here’s some overall rules of thumb.

Facial volume loss: one of the reasons you look older

First, think about what happens when you age. Everyone knows that we lose elasticity as we get older and skin sags, but few realize another primary cause of looking older: facial volume loss. Inevitably, our faces deflate – less so, if we’re considerably overweight.  In fact, isn’t it ironic that as we get older we lose the fat around our face and usually gain it around the middle and other places?

A facelift pulls the tissues upward and tightens sagging. The result: the face looks tighter but the shape still isn’t that of a youthful person.

Just consider the appearance of a young person’s face. Their cheeks are plump and circular. In a youthful person’s face, the cheek usually starts at the lower lids, goes to the nose, down to the level of the lips, and then circles back to the eyes.

With time though, a depression in the tear trough forms and deepens. The tear trough starts at the inner area under the eye, goes downward and spreads outward on the face. As a result, the once round, full cheek is deflated and becomes smaller. We also get hollows underneath the lower eyelids and depressions and shadows in various areas of the face. This is where fillers come in: they restore the lost of volume. Often times the result is dramatic, so much so that many plastic surgeons refer to injectables as a ”liquid facelift.”

There are many injectable filler options, such as Restylane, Juvederm, Artefill, and Sculptra. As part of the overall procedure, these products are often used in conjunction with each other and in addition to Botox. These products are best used in different ways and in different places, and their specific applications vary somewhat, too.

Surgical Facelift: When a Liquid Facelift is Not Enough

With the passage of enough time, you’ll need to address the problems of lost volume and skin elasticity.

And given enough passage of time, both fillers and a facelift are necessary to look your best and youngest.  

Often when one starts seeing a plastic surgeon at a young age, the fillers are used first, and this may delay a facelift for many years. However, if the sagging is advanced or someone has excessive sun exposure and skin damage, it may be best to start with a facelift first, understanding that fillers will be an excellent complement at a later date or even during the actual face lift. Of course, as I said at the start, everyone is different and their problems should be addressed according to their needs.

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