Deep plane face and neck lift after recent filler injections?

Question

Is it necessary and/or beneficial to have filler dissolved BEFORE surgery is performed to achieve optimal results?

Brian M. Harmych, MD, FACS · Answer

Thank you for your question. In many cases, it can be beneficial to dissolve certain types or locations of filler before surgery, particularly when the filler is interfering with surgical planning or could compromise the final result. For example, I often recommend dissolving under-eye filler if it has migrated into the orbicularis oculi muscle or orbital fat, especially when it is causing visible bluish discoloration (Tyndall effect) or persistent swelling within the muscle or subcutaneous tissues. I also dissolve filler when it obscures my ability to accurately assess the anatomy for procedures such as a subnasal lip lift, or when there is excessive filler in the subcutaneous tissues creating contour irregularities.

It’s important to understand that it is not possible to remove all of the filler, but reducing the volume can significantly decrease the risk of complications and improve the predictability of your surgical outcome. Hyaluronic acid filler is hydrophilic, meaning it attracts and retains water, which can contribute to more swelling after surgery. Reducing the filler beforehand can help minimize this.

I hope you find my answer helpful.

Jeffrey Lisiecki, MD · Answer

As with many things, it depends!  If you've just had a little bit of filler, usually that can be worked around without an issue.  If you've had a significant amount of filler where either it's distorting your natural features or where it would give unfavorable shape once your face is lifted, dissolving it in advance is best.  This can take a couple of sessions to do sometimes, which I space out by a couple of weeks and try to finish at least 2-4 weeks before surgery.

Stephen Prendiville, MD · Answer

I get asked this question quite a lot, since many of my facelift patients have had fillers. Is dissolving filler necessary before having a deep plane facelift?  The answer is "it depends", but generally it isn't a necessity.  Am evaluation of your specific situation would be necessary to determine the best response.

Ran Y. Rubinstein, MD · Answer

Hello and thank you for your question. Filler does not routinely need to be dissolved before a facelift when done correctly and the results are natural. If there is concern for filler migration, filler placed too superficially, or an unnatural appearance, then there would be a benefit to dissolving prior to surgery to ensure the best possible outcome. Hope this helps! Esther Litenatsky AGACNP-BC on behalf of Dr. Ran Rubinstein MD, facial plastic surgery in Newburgh, NY and Montvale, NJ.

Erman Ak, MD · Answer

Hi, In most cases, I do recommend dissolving filler before surgery especially for facial procedures because it allows to operate on natural tissue structures, leading to more precise and long-lasting results. However, whether it's necessary depends on the type, location, and amount of filler present. Erman AK, Dr. MD, Plastic Reconstructive & Aesthetic Surgeon

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Danielle122,

Great Question.  Yes, in many cases, it is necessary and beneficial to have dermal filler dissolved before surgery to achieve optimal results. 
Here’s why:
1.  Restoration of Natural Anatomy
2. Better Surgical Precision – Residual filler may obscure true tissue volume, making it difficult for the surgeon to assess what needs to be corrected or enhanced.
3. Reduction of Inflammation or Scar Tissue
4. More Predictable Healing

In my opinion, dissolving should occur at least 2–4 weeks before surgery to allow full breakdown of hyaluronic acid fillers and resolution of any inflammation.

I hope this helps.

Best,

Earl Stephenson, Jr, MD, DDS, MBA

Nashielli Torres Espinosa Chiu, MD · Answer

Hi! It’s a great question, and it’s important to understand that dissolving fillers before surgery isn’t always necessary, nor is it always completely possible.
In many cases, residual filler may be present even after using hyaluronidase, and it might not dissolve entirely, especially if the filler was placed deep or if it’s been there for a long time. However, having fillers doesn’t necessarily compromise surgical results, particularly if the surgeon is experienced in navigating around these areas.
If the filler is causing unnatural volume or affecting facial contours, then dissolving it beforehand could help achieve more balanced and natural results during surgery. On the other hand, if the filler has mostly metabolized or isn’t significantly altering your facial structure, it may not be necessary to dissolve it.
The best approach is to have a thorough consultation to evaluate your unique case and determine whether dissolving the filler would enhance the surgical outcome. I hope this helps, and I wish you the best in your journey to achieving the results you desire!”**
This response educates the patient about the limitations of dissolving fillers while also explaining that the necessity depends on individual circumstances. It positions you as an experienced and thoughtful surgeon who customizes the approach based on each patient’s needs.

Gianfranco Frojo, MD · Answer

No, it is not necessary. It will certainly help with final outcome and predictability intraoperatively/postoperatively.

Bianca Knoll, MD · Answer

thank you for this great question. The short answer is yes. Although fillers rarely dissolve completely, it will be of advantage for your outcome and longevity of your facelift result. In case lipofilling is used with your facelift, the take of the cells will be better and therefore the predictability of your outcome. I hope this helps.

Edward Daniele, MD · Answer

This is a great question. Each plastic surgeon is different in how the approach this scenario and it ultimately depends on the type of filler used (hyaluronic acid based) vs. something more permanent as in Radiesse or a collagen inducer like Sculptra. 
Generally if it is hyaluronic acid based filler, there isn't a need to dissolve it prior to surgery but you should discuss the timing with your surgeon. You should not get injected RIGHT before your surgery (within 2 weeks) since the inflammation alone from the injection can confound things during the surgery. 
For something as in sculptra, it could cause more inflammation so you should probably wait closer to 6-8 weeks after your injection to undergo your facelift.
The short answer though is no, you shouldn't need to dissolve your filler prior to your facelift surgery.

Deep plane face and neck lift after recent filler injections?

Answers (14)

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