Injectable filler is a powerful, minimally invasive treatment that can do a lot of things. It can conceal marionette lines around the mouth, smooth bumps on the bridge of a nose, chisel a jawline, and even plump up saggy earlobes—all with barely any downtime and practically immediate results, save for some potential minor swelling and/or bruising. As incredible and far-reaching as filler is though, sometimes it just makes more sense to opt for plastic surgery instead.
“Filler hits the end of the line when you are no longer trying to restore volume,” says Dr. Ari Hoschander, a board-certified plastic surgeon in Rockville Centre, New York. “Fillers are used to restore volume to the skin and the face in areas where volume may have been lost. When you are trying to correct structural problems, like sagging skin and fine lines and wrinkles, these are not [best] treated by filler.”
Ahead, we’re highlighting some scenarios in which plastic surgery is likely the better choice versus injectable filler. While surgery is more invasive and expensive than an in-and-out procedure such as filler, the plus side is that you’re likely to see better, longer-lasting results.
1. Facial laxity
As we age, volume loss occurs in our face, which can result in sagging or drooping in the cheeks, nasolabial folds, and around the jaw (“jowling”). While you can lightly improve the appearance of mild facial laxity with certain treatments—such as Thermage, Ultherapy, Fractora, and Morpheus8—filler isn’t going to help a whole lot here.
“To correct [facial sagging], injectors will often place filler in the cheeks, temples, nasolabial folds, and prejowl sulcus as well as posteriorly in the jawline. All of these actions try to lift the face,” notes Dr. Catherine Chang, a board-certified plastic surgeon in Beverly Hills, California.
However, she says, what often ends up happening is that you might see some minor improvement in terms of lift but the face ends up looking full and wide, due to the amount of filler required. It’s also a temporary solution.
“I find that a surgical intervention with a deep plane facelift and/or neck lift results in a much more natural appearance and helps to improve the appearance of the jawline, lifts the cheeks, and softens the nasolabial folds,” Dr. Chang says. “A face and neck lift will help to restore the position of the soft tissue instead of camouflaging, like filler. And those with significant jowling will benefit more from a facelift, which directly addresses the sagging.”
2. A disproportionately large nose and/or breathing issues
Nonsurgical rhinoplasty has become an increasingly popular option in recent years. There’s no doubt that it can make a notable difference in facial symmetry and improve minor imperfections.
“There are many patients who can benefit from adding filler to their nose, especially those with minor contour problems,” notes Dr. Tanuj Nakra, a board-certified oculoplastic surgeon based in Austin, Texas.
However, filler does have limitations in terms of rhinoplasty, and not everyone is a candidate for that enticing “lunch-hour nose job.” For starters, Dr. Nakra says that those with larger noses may find that a liquid nose job actually makes the nose even larger, which may not be preferable. Also, it’s not ideal for those with significant asymmetries and constructional issues.
“There are many patients seeking aesthetic nasal refinement who are poor candidates for a filler rhinoplasty,” says Dr. Nakra. “Situations that are not amenable to filler rhinoplasty include a disproportionately large nose, severe asymmetry, a bulbous—or large and boxy—nasal tip, and internal breathing issues. These patients really need surgery to help address the anatomic issues directly.”
3. A recessed chin
Filler is an excellent tool for temporary jawline contouring, but it may not be the best option for those seeking a more permanent, defined-looking chin.
“If someone is a candidate for a chin implant, I always recommend a chin implant over filler,” Dr. Chang says. “Filler is soft and, over time, can look amorphous and saggy. [With a chin implant], you can expect to have an improvement in the overall balance of your facial profile and improvement in the contour of your jawline.”
A chin implant also yields a firmer, more defined look, and it’s a permanent fix versus one you’ll have to consistently go back to treat each year. What’s more, Dr. Chang says that the procedure can actually help with more graceful aging, especially in the case of a genetically weak or recessed chin.
4. Very thin lips
Dr. Nakra says that lip filler is very helpful when targeting an isolated volume issue—and the ideal candidate is someone with mild age-related volume loss or a mild case of thin lips. In either case, a small amount of filler can go a long way and look very natural when placed by a skilled injector.
“If the lips are genetically very thin, then a surgical lip lift can be far more effective than fillers because the lip lift will ‘flip’ or rotate the lip outward, [causing the lips to] look fuller more naturally,” explains Dr. Nakra.
He adds that another scenario where a surgical lip lift is often more effective is in age-related lengthening of the upper lip. Dr. Nakra explains that as we age, the distance between our nose and mouth increases. Lip filler cannot fix this issue. In fact, filler can potentially cause distortion and cause the lip to drop even further in this scenario.
Where filler fails, a surgical lip lift decreases this space in a natural-looking way. It also permanently changes the overall shape of your lips, increases the fullness in the upper lip, and shows more of your upper teeth when smiling, notes Dr. Hoschander.
5. Sunken under-eyes
We tend to zero in on the area around our eyes as an indicator of our aging. After all, this area tends to show some of those first signs with fine lines and wrinkles, eye bags, and hollowing. When it comes to hollow or sunken under-eyes, however, both Dr. Chang and Dr. Hoschander say that filler is rarely their first choice.
“If it is a small amount, I think it is OK, but repeated placement or a lot of filler placement in the lower eyes can lead to swelling of the lower-eye area. This can be tough to correct,” Dr. Chang explained. “I usually, instead, recommend surgical correction, to truly address the anatomic issue rather than trying to camouflage the area with filler.”
Dr. Hoschander agrees, adding that under-eye filler comes with some non-negligible risks. This ranges from minor side effects such as tiny nodules or bumps to, more rarely, blindness that can occur if the filler is injected into a blood vessel.”
The preferred surgical treatment is a transconjunctival lower blepharoplasty. This outpatient procedure requires roughly a week of downtime, due to bruising and swelling, but promises dramatic and long-lasting results.
When in doubt, a consultation with a plastic surgeon can help you determine the best path forward to reach your aesthetic goals.
