I am confused - would I benefit more from a facelift or fillers? (Photo)

Of course the med spa will recommend fillers and you’ll spend a lot of money by the time you realize you should have had a facelift. If you want to start slowly and not spend a lot of money consider having your upper lids done. That would be an excellent start and a lot of bang for the buck

Dear terriebari,
Thankyou for your attaching pictures for reference. It seems you are experiencing face laxity where the skin is losing its firmness and tightness especially in the mid-face area. If you are looking for a permanent solution, In my opinion, a full-face lift seems to be the solution, this way it will target the loose skin in the neck, jaw area, midface and temporal area combined with Upper and Lower blepharoplasty, the lift will eliminate the sagging cheeks/nasolabial folds and the blepharoplasty will remove the excess skin in the upper and under the eyes and prevent your skin to collect under the eyes when smiling. Furthermore, I would also suggest that you get fat injections for your deep smile lines to fill in the lack of volume. For the midface lift and lower blepharoplasty i would strongly suggest finding an expert surgeon who does endoscopic scarless lift and follows the vertical lift technique in order to get much natural lifted look.
Best Regards,
TAS TEAM

This is a fun question. Both of these treatment options, facelifting and fillers have their benefits. The facelift is the most powerful tool to improve the jowels and laxity in the central neck, both of which you have early signs of. Filler is best to improve the upper facial deflation that also occurs with age. Ideally however, injectables are used very lightly in the lower face, to avoid exacerbating the facial shape changes that occur with age: shrinking of the upper third of the face and expansion of the lower third, making the face look less heart shape and more square. Fillers for volumizing the loss of cheek, brow and temple are useful in the sense that they can be done in an office, in a staged fashion as the budget permits and can be reversed with enzyme. The downsides however are that they are a volume source that has a relatively high rate of "cosmetic complication" whereby it can look unnatural, puffy, or discolored. Unfortunately, if fillers are continued, the chance of one of these cosmetic complications occurring does get higher. The ideal approach uses a neck/facelift to slim the lower third of the face and more natural volume sources such as sculptra or fat grafting for the upper third. Hope this wasn't too confusing of an explanation!

Given your photos, it appears that there is some descent of the deeper facial structures and excess skin. Fillers are good ONLY for adding volume. I would recommend a facelift / necklift with facial fat grafting but these are only recommendations that truly need a physical exam prior to providing any official recommendations. I would highly recommend seeing a board eligible or board certified plastic surgeon for a physical exam and accurate analysis with safe recommendations for potential surgical options. Best of luck!

A discussion of your concerns is important here, as well as a physical evaluation, but they are both "right" in a sense. A facelift alone will not give you the volume you need for facial rejuvenation. This is why modern facelifts are done with fat grafting at the same time. Both facelift and fat grafting address things that the other cannot. The amount of volume you need for facial rejuvenation could not safely or sanely be accomplished with fillers alone, and just fillers will not tighten any of the structures that have become lax with aging. Comprehensive facial rejuvenation requires both.

Thank you for question in sharing your photographs.

It is a dilemma for many people that are looking to maintain their facial aesthetics and the turning point is not necessarily clear. It is also fair to say that there is no direct conflict between having surgery and having fillers. They offer different types of solutions and to some degree they are complementary.

I would suggest that the easiest way for you to decide whether surgery is right for you is to simulate the impact of facelift as the injectable fillers would never be able to do the same.

To this effect, if you lie down completely flat and hold a mirror in front of you, you will be able to see changes of the facial shape that reflect relatively well the impact that you can expect from a well executed facelift and probably more likely from the deep plane facelift.

Unfortunately, fillers cannot produce the reduction in volume in the lower face, and as a result, building the volume in the mid-face is tailored against a contour of the jawline that is heavier than what you had in your 20s. This can mean that the end result would be of facial features are too full.

This can create the perception that the lower face has become dominant compared to the appearance of the eyes. Redistribution of the volume such as created by facelift surgery, reduces the overall surface of the face by reducing the size of the lower face and enhances the visibility of the eyes. This is most likely mechanism of comparison that we apply subconsciously.

Hello, thank you for your question. Both fillers and a facelift can provide you with natural, youthful results when completed by a board-certified facial plastic surgeon or expert injector. Choosing the procedure that is right for you can include expectations about recovery, maintenance, and results. Injections provide short-term effects that can help with volume, wrinkles, and facial balance without invasive surgery. They also require regular maintenance and limited results. If you are looking for more dramatic and long-term results that would potentially eliminate regular filler injections and don’t mind a longer recovery, a facelift may be right for you. A facelift can target many concerns and areas with one procedure, such as excess fat, tightening muscles, repositioning sagging skin, higher cheeks, and smoother skin. A good facial plastic surgeon will know how to reposition underlying tissue to create the volume you need to maintain a youthful contour. You can also combine a facelift with filler injections or fat grafting to enhance the results. Consult with an experienced facial plastic surgeon to learn more about a facelift or other treatment options to target your needs.

Hello, thank you for your questions. This is a common question. Fillers are a non permanent solution to help soften deep folds ie marionette lines and nasolabial folds but also gives volume to areas such as cheeks and temples that we naturally loose over time. Ideally utilizing both facelift and then fillers for volume would be a good combination. Facelift is a surgical procedure that removes and tightens the skin in the lower portion of the face and neck. As you previously told it does not add volume. You can add to this surgery by getting a blepharoplasty. I would suggest looking at before and after photos of facelifts to see the outcomes of this. Check out out website for more information and photos.

Thank you for your question. As we age, we lose volume and soft tissue descends as well. Correcting one or the other helps, but will often eventually give an appearance that's unnatural. If you just add volume, over time there is a risk that the face will look overfilled and bottom heavy. If you just lift the tissue, sometimes the face can still look hollow. For the most natural result often both are necessary, although this will also depend in individual anatomy. For example, in about half of the facelifts and lower eyelid surgeries I perform, I accompany them with fat transfer, which acts as a natural and permanent filler. I hope this is helpful, and all the best to you.
-Dr. P

The truth is that fillers/neurotoxins, surgery, and skin care can all be beneficial for maintaining a refreshed, youthful appearance – it just depends on what one’s wishes are, and at what stage of the ageing process one finds oneself. As we age, there are many biological processes occurring, including loss of collagen/elastin, and unwanted fat loss/gain. Maintaining an attractive appearance is a multidimensional task that is ongoing and never “done,” because you will continue to age as time passes. Surgery can address folds and loose skin but it can not improve wrinkles on your forehead/around your eyes/on your upper lip. Based on your pictures, it appears you have loose skin under your neck that might be best be addressed with surgery. The volume loss in your midface might benefit from autologous-fat transfer and plication of the SMAS layer, both of which can be performed in surgery. Botox could address the frowns between your brows and what might be lipstick lines forming on your upper lip, or a deep laser that would be performed in the operating room. (Keep in mind, an in person consultation would be needed to properly determine the most effective plan for your wishes.) If you are bothered by your upper and lower eyelids, a blepharoplasty could refresh this area. And finally, many patients do not realize that a subtle rhinoplasty can be very youthening, because as we age, noses can appear more prominent and can develop a downturned droop. It’s truly up to you what you wish to correct, but I would – just based on your photos – not recommend that you turn to fillers only, because the amount of product necessary to correct the natural ageing process would make you look distorted and unnatural. Less is always more – in fillers, Botox, and surgery.

Hello @terriebari, thank you for your question. As with all procedures, it depends on your expectations of the results. Surgically correcting skin laxity generally results in a long term solution and improves aging features in a more comprehensive way, whereas non-surgically correcting features tends to improve some aspects of the skin in a partial way over time. For a proper assessment I suggest you consult one or several board certified plastic surgeon for more information and options. Best wishes! Alan Gonzalez MD FACS