Should I do a combination of filler and Facelift? (photos)

My nasal folds got deeper and now have indentations to the sides of those nasal folds including slight undulations leading to the ear. I would describe it as a deflated and tired look. I've looked into fillers and have done nothing yet. I highly doubt fillers alone will make a difference and I'm hoping a facelift will achieve much better results. My side profile is the worst part of this change. More pronounced on my left side. Also particularly disturbing. Your thoughts please. Thank you

Doctor Answers 25

Should I do a Combination of Filler and Facelift

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One's page is best guessed by the appearance of their face. If you feel that your face does not reflect how young you feel inside, you may be a candidate for a facelift. During your #consultation,  your skin texture and elasticity, as well as your underlying skin structure and your facial bone structure will be evaluated. Based on this evaluation, your board certified plastic surgeons will create a custom surgical plan, detailing specific techniques and recommendations to meet your goals. In doing so, he or she should be sure to have a full understanding of what results you expect. 

If you are not a #candidate, your surgeon can make other suggestions to address your concerns and objectives.

A Facelift Creates Much More Dramatic Results

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I agree that fillers will not be sufficient to deal with the significant tissue relaxation in the midface area. That is best dealt with using a thorough release of the deep fascia (SMAS) attachments, which lie deep beneath the subcutaneous fat, and repositioning those structures in a more natural and complete way than procedures that rely on sutures to pull the deeper tissues without completely releasing them. Fat transfer, which I do routinely at the time of surgery, will add volume and further enhance the improvement of the nasolabial fold and the deflation in the cheeks, but it should not be overdone.  Fillers are more temporary and less natural: With the aging process, fat is lost. It makes the most sense to replace like with like.

Aging of the Face is Multi-Dimensional

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Thanks for your question.  I think the first step for you is to have a consultation with a board certified plastic surgeon who can properly evaluate and recommend what would best address your concerns.  The facelift would help eliminate your excess skin and tighten, the fillers would help bring back your loss of volume.  You could even consider fat transfer as an alternative to the fillers.  Do your homework and visit a surgeon who has done many facelifts.  Best of luck in your search.

Facelift & Fillers

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Based on your photos, yes, I think you would get the best results with a facelift and some filler. The lift will eliminate loose skin and muscle while the filler will restore volume to the mid-face which will address the sagging jowls. My best advice would be for you to schedule a consultation with a board certified plastic surgeon to be assessed in person and discuss your options.


Kouros Azar

Consider Fat Transfer During a Facelift

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As we age, we lose facial volume, especially in the cheek/midface region. This contributes to the sagging as well. In order to obtain the best rejuvenation procedure, the areas that have sagged should be lifted, and the areas that have lost volume should be filled. Nasolabial folds and marionette lines do not change much during a facelift. The true treatment for these regions is fillers. A great way to lift and fill is to use your own fat as the filler at the same time that you have a facelift. The lift will elevate the sagging tissues, which more directly addresses the lower third of the face (neck, jowls). The fat transfer will then replenish volume in the midface (cheeks), nasolabial folds, and marionette lines.  This will give you the best result. 

Facial aging: Skin, volume, and muscle

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In your facial aging pattern, it's very important to look into addressing the muscle looseness with a facelift, the volume loss with either fat transfer or filler, and the skin excess with a facelift as well. Avoid overdoing filler in place of a facelift because it will look unnatural and will not achieve what you want. A facelift alone may come close, but without restoring the volume, I believe it will fall short of what it is that you are trying to achieve. 

Filler and Facelift

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As we age, the face loses elasticity leading to muscle and skin drooping. Another facet of the aging process is the loss of fat that creates an aging, hollow appearance. Total facial rejuvenation requires lifting technique, as well as volume restoration. Man-made fillers, such as restylane or juvederm, can be utilized as the same time as the facial procedure. A very popular procedure is fat transfer to the face. This is a procedure in which fat is harvested from the abdomen and the healthiest fat cells are then transferred back into the face to restore that youthful fullness. These typically are done at the same surgical procedure. 

Facelift and cheek implant candidate

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The photographs demonstrated loose and inelastic facial and neck skin, along with a deflated mid face with loss of volume. When patients have a flat maxilla and loss of volume in the cheeks, fillers offer a temporary augmentation. Cheek implants offer a permanent augmentation.  In our practice, the goal of a lower face and neck lift is to lift the jowls, tighten loose facial and neck skin, tighten loose facial and neck muscles, remove the fatty deposits in the neck along with a platysma plasty. For more information and many examples of both procedures, please see the link and the video below

Find the right surgeon to help you decide

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If you feel that your face does not reflect how young you feel on the inside, a facelift may be the solution to help you look and feel younger. During your consultation, your doctor will evaluate your skin texture and elasticity, as well as your underlying skin structure and your facial bone structure. Based on this evaluation, he/she will create a custom surgical plan, detailing specific techniques and recommendations to meet your goals. Your doctor should make sure you have a full understanding of what results to expect.Always insist on a board certified surgeon!

Facial rejuvenation... what to do?

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Thanks for sharing your question. I can appreciate your concern.

Your question is very well taken. I partially agree with you. however, there is more depth to the concept of facial rejuvenation rather than a simple there are excellent or mediocre surgeons.

facial rejuvenation if more than pulling skin. It is based on 4 basic components: 

1. improving the quality of the skin

2. improving deep and light wrinkles

3. improving volume

4. repositioning of tissues.

In your case a combination of the 4 components will be necessary to obtain the best result. A combination of botox, fillers, skin resurfacing and a face lift should give you the best outcome.

Finally, make sure that you have a consultation with a board certified plastic surgeon.

Wishing you the best in your journey

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.