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 23

Aging of the Face is Multi-Dimensional

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

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

Kouros Azar, MD
Thousand Oaks Plastic Surgeon
4.8 out of 5 stars 21 reviews

Consider Fat Transfer During a Facelift

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

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. 

Mark Karolak, DO, FAOCO
Bridgewater Facial Plastic Surgeon
5.0 out of 5 stars 36 reviews

Filler and Facelift

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. 

Brett E. Stompro, MD
Bay Area Plastic Surgeon
5.0 out of 5 stars 7 reviews

Facelift and cheek implant candidate

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

William Portuese, MD
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 126 reviews

Find the right surgeon to help you decide

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?

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
4.8 out of 5 stars 32 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.