These Procedures May Make a Future Facelift More Difficult

Have you noticed how much younger everyone looks these days? A meme that’s been circulating the internet for a while contrasts images of Golden Girls actress Rue McClanahan and Jennifer Lopez, both at age 50 or so, to drive the point home. A big part of this is due to the evolution of plastic surgery techniques: Earlier forms of facelifts focused on tightening and pulling back surface-level tissues, which created that infamous windswept look. Today, surgeons are going much deeper, to tighten lower tissues—and even the muscles—lifting them back and up and leaving behind a more natural-looking result. The addition of facial fat grafting and sculpting further enhances outcomes and can take a significant number of years off one’s appearance. 

But often, the real reason people appear more youthful is that they’re putting in the work well before going under a surgeon’s scalpel; the focus on prejuvenation has only heightened this phenomenon. We’re turning to faithful use of sunscreen, becoming devoted to professional-grade skin care, and experimenting with new procedures that claim to offer results comparable—or at least similar to—those of facelifts. It’s truly amazing to have all of these options today, but if you end up wanting a true facelift in the future, some of these shortcuts could ultimately hinder you. 

It’s critical to remember that every patient is different. While the procedures below can negatively affect some individuals, they may not cause problems for others. To get the best outcomes now—and to increase your chances of having a successful facelift later—you’ll need to see experienced, board-certified providers and be honest with them about your full treatment history.

Injectable fillers

If you’re using hyaluronic acid–based filler conservatively, all of our experts agree that you won’t have too much to worry about, though it’s worth noting that the filler you got years ago may still be lurking in your face. “This happens a lot with the eyes,” notes Dr. Jennifer Levine, a board-certified facial plastic surgeon in New York City. “People will have under-eye filler you can still see, even if they haven’t gotten it for 10 years.”

In these cases, you’ll need to be treated with hyaluronidase, sometimes several times, to dissolve what’s left. 

It’s when you’ve been using too much (or biostimulatory fillers, which we’ll get to shortly) that you may run into some problems. “If a patient really desires to look like they did when they were in their 30s but has spent the past 15 years piling filler in their face and has permanently changed the original shape of the face, there is no way to go back to a 30-year-old face,” warns Dr. Amir Karam, a board-certified facial plastic surgeon in San Diego. 

Years and years of using filler to create that pillowy look stretch out the facial tissues in multiple directions, causing a dependency on volume that your provider may not be able to rectify through fat grafting. “You’re never going to get a good result,” says Dr. Ben Talei, a board-certified facial plastic surgeon in Beverly Hills, California. “Not because you can’t go in there and lift the face, but because you have inhibition in how much you can lift the face—even if you lift it to the sky, they’re going to have deflation issues afterward.” 

In other words, overfilling the face stretches the tissue to the point that it will never return to its original elasticity; tissue that once acted like a spring, stretchy balloon is now more like a ziplock bag. Those tissues will also not be able to recover as well after being treated with hyaluronidase. “They just don’t have the ability to restore their natural hyaluronic acid like healthy tissue, where you’ll dissolve and then it’s making hyaluronic acid again a few hours later,” Dr. Talei adds.

The fillers that are more likely to create issues when going in for a future facelift are biostimulatory formulas like Radiesse, Sculptra, and Bellafill, which cannot be dissolved. While they sound good in theory, as they’re marketed as products designed to produce new collagen, there is a risk that they’ll create scar tissue in the process, which is harder to cut through and reposition. 

Fat removal and skin tightening treatments

There are many, many procedures that fall into this category, ranging from noninvasive and minimally invasive to surgical options. Generally speaking, you don’t want to remove fat from your face. “You have to understand how people’s faces age,” says Dr. Levine. “It’s very difficult to give that youthful softness back to the face once you’ve made it more angular, which just makes you look older.”

One such example is Kybella, an injectable commonly used to remove a double chin. When used improperly, it can create contour irregularities that may not be correctable surgically, says Dr. Karam. These are usually caused because the medication was injected too deep under the platysma, which runs along the lower jaw, across the neck, and all the way down to the upper chest. “There’s really not much fat laterally there,” says Dr. Talei. “There’s only fat centrally in the neck, and so you end up with these indentations in the middle of the neck, under the chin.”

To address unwanted fat as well as tighten facial skin laxity, deep radiofrequency microneedling and wand devices (such as FaceTite, AccuTite, and Renuvion) have become incredibly popular. If you’re using these treatments to remove small amounts of supraplatysmal fat, says Dr. Talei, you’re totally fine. But if you’re using these devices on the face, you want to proceed with caution. “Attempts to use deep radiofrequency microneedling to tighten up deep muscle or fascia come at the cost of potentially melting and damaging that subcutaneous fat layer, because the fat is directly under the skin,” warns Dr. Karam, who spends a lot of time educating the public on this issue through his social media platforms. “These energy devices place energy through the skin, through the fat, on their way toward the deeper fascia and, along the way, damage that subcutaneous fat.” If you’ve seen the complaints on TikTok about RF microneedling making patients’ faces look older, this is why—fat keeps the face looking young. These pose an even greater risk to your facial fat’s integrity when performed poorly or aggressively.

Threads

Whether a history with threads will be a problem depends entirely on the skill of the provider and the materials they used. The most common threads used today are made of polydiaxanone (also known as PDO). It’s the same material used for sutures. If placed correctly, with proper facial structure in mind, PDO won’t create too many issues, but it’s also unlikely to do much for you. “The results are extremely temporary and have all the inherent complications associated with any invasive or minimally invasive procedure, like infection, irregularities, and pain deformity,” Dr. Karam says. Adds Dr. Talei, “The only place that it seems to have had any positive effect beyond what a filler can do is maybe in the lateral midface.”

Threads can also create some scarring beneath the skin’s surface. “When you put absorbable suture material into the face, your body tries to eat it back up,” says Dr. Talei. “In the process, it ends up depositing some granules of scar tissue.” Dr. Karam notes that PDO threads tend to leave only streaks of scar tissue behind. When well placed, these threads may not even be visible: “I just did a facelift on someone that I had personally put threads in, and I could not see where I’d put them in her face,” says Dr. Levine. However, permanent threads can create challenges for surgeons; they can create more scar tissue and must be removed during surgery. 

Acne

OK, so this is, admittedly, not a procedure, but it’s still a common issue that can affect a surgeon’s ability to perform a facelift. A handful of blemishes over the years won’t cause a problem, but decades of severe acne and acne scarring can. “When operating on some patients with acne and lots of acne scarring, you go in and find really distorted tissue planes [and the patient] bleeds a lot,” says Dr. Talei. “Ultimately, this won’t stop the best surgeons.”

Prior facelifts

After getting one facelift, you’d think that getting a second more than a decade later (and we’re not talking about revisions) would be fairly straightforward. Not so. “We tend to operate in something called the avascular plane, which doesn’t have blood vessels in it, making dissection very easy,” says Dr. Levine. It’s easy to cut through this plane on a patient who’s never had prior surgeries or scar tissue from the aforementioned procedures—not unlike gliding a scissor through wrapping paper. But if there’s lots of scar tissue under there, “it’s like cutting through cement,” she says. This makes for a much more challenging, time-consuming, and high-risk procedure. In many cases, your provider won’t know if they’ll encounter these issues until they’ve begun to operate, which is why it’s so important to see a skilled provider—ideally, one who performs multiple facelifts a day rather than a handful a month. The former will be more comfortable in these situations than those with less experience. “If you’re used to working in these fields, you just take your time and get through the dissection more slowly, more carefully, to avoid any structural damage to important anatomy like nerves and blood vessels,” says Dr. Karam.

Another way that a previous facelift can make a subsequent facelift harder to perform is the vector used. “For example, if a prior surgeon pulled the face sideways and you’re trying to pull the face vertically, the horizontal vector in front of the ear often leaves a challenge,” says Dr. Karam. This means it may be very difficult to close the skin back up after surgery, as too much could have been removed previously. “Sometimes you run out of skin in a direction that you feel is a more natural vector for rejuvenation,” he explains. “If the appearance is too extreme as a result of the previous surgery, we will have to forgo the opportunity to perform the surgery for the patient.” 

None of this is to say though that providers expect you’ll avoid any and all aesthetic procedures in order to make a future facelift easy. “It’s naive, as a surgeon, to assume that by the time someone is going to need a facelift, they won’t have done any noninvasive procedures,” says Dr. Levine. “Yes, in an ideal world, having something that’s never been touched before is much easier to operate on… but people want noninvasive treatments. Science and innovation are going to continue to move forward, and it’s up to us, as doctors, to intelligently evaluate treatments to determine if they’re safe and effective for our patients.”