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 16

Facial rejuvenation... what to do?

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

Should I do a combination of filler and Facelift?

 Hi, I have performed facelifts for over 30 years and have performed many minimally, invasive type facelifts.  From the photos your cheeks are extremely flat anteriorly (in the front) which creates the lack of tissue support in the mid face and leads to the deep nasolabial folds, jowls are present and the chin is weak.  These factors combine to create a rectangular shaped face with excess sagging tissues in the mid face and neck. 

 Following the beauty principles outlined in my book on face and body beauty, men look chiseled and handsome with angularity in the cheeks, chin and mandibular angles.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create volume and angularity to the mid face.  Due to the extreme flat nature, of the cheeks, in my humble opinion the tissues need the support of cheek implants however it's certainly reasonable to start with an "off the shelf" dermal filler to see if it provides the desired result.  I prefer using Restylane Lyft for that area. 

 When the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.   I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.

 "Jowls” are sagging facial tissues and an indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.

My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:

  • very small incisions
  • minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
  • can be performed in 90 minutes or less, with or without general anesthesia
  • no incisions within the hair = no hair loss
  • excess fat can be removed
  • excess skin removed
  • cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
  • most patients fly back home to parts all over the world in as little as 3 days post-op

I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

What to do for excess facial skin, loss of volume and Sagging Forehead and Brows?

What to do for excess facial skin, loss of volume and Sagging Forehead and Brows?  your assessment is correct. The only thing you left out was your sagging forehead and brows which greatly make you look angry and aged. This can be corrected with a brow lift done at the hairline with the hair buried so as not to show a scar (Irregular Trichophytic Forehead Lift) since  The hair grows through the scar not behind it. You also need a full face neck lift and possibly a cheek lift with cheek implants for volume rather than fat. Cheek plants can be adjusted for size shape and symmetry and removed easily were as fat cannot be. See a very experienced facelift surgeon who can show you pictures of his results which look natural as well as the hairline scar.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 32 reviews

Natural Looking FaceLift

I don't use fillers in combination with my face lift.   If anything I use fat injections- it's natural and the body doesn't reject or have adverse effects from it.

Grant A. Fairbanks, MD
Salt Lake City Plastic Surgeon
5.0 out of 5 stars 5 reviews

Face lift vs fillers

Thank you for your question and for attaching pictures. You are correct in the fact that fillers alone are not going to achieve your desired results. In my opinion a face lift with fat grafting would be a good option for you. It may take an additional 2-4 fat grafting procedures to achieve the best results. If you are not interested in the fat transfer option, a face lift and adding filler will soften your deeper folds and augment your cheeks. You will have to repeat the fillers every 1-2 years depending on the filler used. Sculptra would be another nice option, though my favorite option is still fat transfers. Find a board certified plastic surgeon in your area who is a member of ASPS and ASAPS. Look for someone who specializes in facial rejuvenation and has experience with male face lifts. Your surgeon will be able to discuss the options available to you. Good luck.

Face lift and fillers? What will help?

Thank you for asking about your facial surgery.

  • Your self-assessment is very perceptive.
  • I agree fillers alone will not be the answer -
  • you would need a huge amount to see any improvement at present.
  • I suggest you consider a face and neck lift with a combined malar/mid-face cheek implant.
  • This will add support and volume to your upper and mid face.
  • then after you heal from surgery, you may need a modest amount of intermitted fillers to maintain the look.
  • in the meantime, you might consider a little Botox to your forehead to smooth the lines 
  • You are a handsome man and a little forehead smoothing will help show you at your best, while you decide about surgery.

Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Deel nasolabial folds

Fillers or face lift alone will not be enough. I would recommend a face lift with fillers in the cheeks and midface. There are various options for fillers from Radiesse (1 year) to Sculptra (3-4 yrs) to Bellafill (5-10 yrs). I have had really good success with fat grafting done at the same time as a face lift, that way you have 1 healing period. Fat grafting when done well looks amazing and is long lasting. I do a high-SMAS lift which will lift the cheeks and nasolabial folds. See web reference for an example of my patient who underwent simultaneous face lift and fat grafting. Fillers (instead of fat) will work too but they can be expensive if you need a lot. Advantage of fillers is basically no recovery while fat grafting causes a lot of swelling for 2 weeks, which is why it is advantageous to do it with a facelift since you are healing from that anyway. Come in for a consult, we will discuss it in more detail, we are in Fresno.

Peter T. Truong, MD
Fresno Oculoplastic Surgeon
4.9 out of 5 stars 30 reviews

Facial Aging Solutions

I agree with your observation of "deflated and tired". Aging is the process of volume loss which creates a tired or stern appearance. It is different for each person depending on their genetics/facial construct. Options for volume replacement include solid implants or fillers. My preferred filler for the past 15 years has been fat...long lasting, natural appearing, and the liposuction is a bonus! Adding the facelift enhances the effect of the volume fill and the volume allows for a more conservative skin resection. Its a symbiotic relationship that gives a fresh and natural appearance. If you do decide on fat, you will likely require 2-3 sessions depending on the success of the intial treatment due to the extreme volume deficit present. Hope this helps!

Best Regards, 


Kirk A. Churukian, MD
Los Gatos Plastic Surgeon
5.0 out of 5 stars 4 reviews

Facelift with filler?

It looks like you are a good candidate for a facelift, but a regular facelift will not improve the nasolabial folds. A deep plane facelift where the cheek ligament is released will improve the nasolabial folds as well as the jowls and neck. Regarding your volume loss, I'd recommend fat grafting and / or cheek implants. The implants are more reliable in their ability to give you volume for the rest of your life, but fat grafting can be highly customized. See someone who specializes in facial rejuvenation so you can have an honest discussion about all of these options.

Andrew Campbell, M.D.

Facial Rejuvenation Specialist

Quintessa Aesthetic Centers

Andrew Campbell, MD
Milwaukee Facial Plastic Surgeon
4.7 out of 5 stars 26 reviews

Facelift with Filler vs autologous tissue

There are several techniques of permanent volume augmentation that can be combined with a facelift.  Make sure your expectations are realistic, and don't try to fill all the missing volume, or the results may be quite lumpy and unnatural.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 133 reviews

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.