Fillers make future facelift difficult, but are hyaluronic acid based fillers more acceptable?

Question

More scientific literature and surgeons speaking as to how fillers make future facelifts more difficult (albeit not impossible) given formation of scar tissue. I understand this is particularly the case with non-HA based fillers like Radiesse and Sculptra, but are HA based fillers like Restalyne also "bad" in this regard (ie, making future facelift difficult)? Also - what are places in face that to get filler that least impact future facelift? I understand jawline for eg may be tough given near incision area, but what about zygos, nose, etc? Is it more acceptable if I space out 15 years apart?

Mark Beaty, MD · Answer

This is an excellent and very thoughtful question. You’re correct that opinions vary from surgeon to surgeon. In an ideal world, performing a facelift on a patient who has never had fillers or energy-based treatments is the “cleanest” situation. That said, this is rarely realistic—most patients have had some form of filler or skin tightening treatment before they become facelift candidates.

Generally, if a significant amount of time has passed between your filler injections and surgery, your facelift surgeon usually won’t need to dissolve anything first. The main exceptions are areas where precise anatomy is critical, such as the under-eyes before a lower blepharoplasty or the chin before a chin implant. In those cases, dissolving filler helps the surgeon work with a true picture of your natural tissue.

HA fillers (like Restylane or Juvederm) are less of a long-term concern since they can be dissolved if needed. Non-HA fillers (like Radiesse or Sculptra) do create collagen and can leave behind some tissue changes, but this doesn’t usually make a facelift impossible—it may just require more care from your surgeon.

It’s also worth remembering that fillers are great for restoring lost volume, but they are not a substitute for surgical lifting. As long as you’re spacing out your treatments and being strategic with where filler is placed, most patients transition to a facelift without major issues.

Behnoush Zarrini, MD · Answer

It’s true that long-lasting fillers (like Radiesse and Sculptra) can leave scar tissue that makes facelifts technically more challenging. Hyaluronic acid (HA) fillers such as Restylane are generally considered safer in this regard since they’re reversible with hyaluronidase and tend to integrate more cleanly.
That said, repeated filler injections over many years *even HA fillers* can still create some tissue changes that surgeons have to work around. Areas like the jawline and temples (near incision sites) can complicate surgery more than midface or tear trough areas.
If you’re spacing things out by 10 to 15 years, and especially if mostly HA fillers are used, future facelift surgery is usually still very feasible. Just inform your surgeon about your filler history so they can plan accordingly.

Anna Chacon, MD, FAAD · Answer

While fillers—both HA (hyaluronic acid) and non-HA—can technically make future facelifts more challenging, the degree of impact depends on the type of filler, injection site, quantity, and the time elapsed between filler placement and surgery.

The primary concern is that repeated filler injections can stimulate collagen formation and fibrosis, leading to scar tissue in treated areas. This can make surgical dissection more labor-intensive and increase the risk of irregularities. Non-HA fillers such as Radiesse (calcium hydroxyapatite) and Sculptra (poly-L-lactic acid) are more likely to cause persistent fibrosis since they are bio-stimulatory and not easily reversible.

HA-based fillers (e.g., Restylane, Juvederm) are generally more “forgiving” because:

They are reversible with hyaluronidase

They tend to integrate into soft tissue without the same degree of long-term fibrosis seen with bio-stimulatory fillers

Over time, they are naturally degraded by the body

That said, even HA fillers can cause minor scarring or tissue changes if injected repeatedly in the same area over years.

Regarding injection sites and facelift impact:

High-risk / facelift-incision–adjacent areas: Jawline, preauricular region, lower face (SMAS access points)

Lower-risk areas: Malar/zygomatic area, temples, nose bridge/tip (these are typically away from primary facelift dissection planes)

Mid-risk areas: Nasolabial folds, perioral region (can still affect perioral surgical finesse)

Spacing fillers and facelifts far apart—such as 10–15 years—reduces the impact significantly, as much of the filler will have resorbed and tissue changes will have softened. Still, surgical ease varies by patient and surgeon experience.

In summary, HA fillers are typically more acceptable than non-HA fillers for patients considering a future facelift, especially when placed in midface or nasal regions and used conservatively over time.

Michael Chung, MD · Answer

You are correct that the relationship between facial fillers and future facelift surgery is an important consideration. The primary concern is the creation of fibrosis or scar tissue within the subcutaneous planes where we normally work. This is most often noted with stimulatory fillers such as calcium hydroxylapatite (Radiesse) and poly-L-lactic acid (Sculptra). These products are designed to trigger a tissue response and collagen production, which can create more dense and less predictable planes for surgical dissection. This does not make facelift surgery impossible, but it can increase operative difficulty and, in some cases, affect outcomes.
Hyaluronic acid fillers such as Restylane or Juvederm tend to be more forgiving. They are reversible with hyaluronidase and generally do not create the same degree of long-term fibrosis as stimulatory fillers. However, it is increasingly recognized that hyaluronic acid fillers may persist far longer than previously thought, sometimes for many years, and they can migrate beyond the original site of injection. Migration into surrounding tissues can alter anatomy and in certain situations influence surgical planning. For example, lip fillers can migrate into the upper lip, contributing to elongation and potentially increasing the likelihood of needing an upper lip lift later.
Regarding timing, spacing treatments and surgery widely apart does reduce the risk of interference. A 15-year interval is a significant amount of time, and in most cases residual filler or associated scar tissue would not be expected to pose a major obstacle at that point, particularly with hyaluronic acid products.
Overall, hyaluronic acid fillers are the most conservative choice if future facelifting is anticipated. Careful placement and moderation in volume are equally important. If you are considering long-term surgical rejuvenation, it is worth discussing these issues with your surgeon so that your non-surgical treatments can be tailored in a way that preserves future surgical options.
Good luck! Michael Chung, MDPlastic and Reconstructive Surgery

Justin Buro, MD · Answer

Hello, and thank you for your thoughtful question. This is an important topic that has been coming up frequently in both the literature and in consultations with patients considering facelift or neck lift surgery. When it comes to hyaluronic acid (HA) fillers (such as Restylane or Juvederm), the advantage is that they are generally temporary and can be dissolved if needed. While newer studies suggest HA fillers may last longer than we once thought, the consensus is that they do eventually break down completely. In most cases, they do not create significant scar tissue that would complicate a facelift. 
The bigger concern lies with biostimulatory fillers (such as Sculptra or Radiesse). These stimulate collagen production, which can lead to scar tissue and fibrosis in the deeper tissue planes. This can make facelift dissection more challenging and, in some cases, riskier. For that reason, I recommend caution with these products if you are planning future facial surgery. 
Regarding timing, the best approach is to minimize filler use in the months (or even years) leading up to a facelift. This allows your surgeon to evaluate your natural soft tissue volume and plan appropriately&mdash;often with techniques like fat grafting during surgery. If HA fillers are present close to the time of surgery, some surgeons will dissolve them in the weeks beforehand, while others may carefully address them during the operation itself. 
In my opinion, there isn’t one facial area where fillers are “safer” or “more dangerous” prior to a facelift. What matters most is being open and honest with your surgeon about your filler history, as this helps with surgical planning and ensures the safest, most natural outcome. I hope this helps clarify the relationship between fillers and facelift surgery. 
Best wishes, Justin S. Buro, M.D.

Mostafa Bayati, MD, FRCR, PhD · Answer

Non-HA fillers, such as the 'new generation' fillers flooding the market (examples include HarmoniCa, Sculptra, Radiesse and other calcium hydroxylapatite fillers) are non-reversible. Any facial plastic surgeon will tell you that they are a nightmare to extract during facial surgery and this is the primary reason why I do not inject them. 
By contact, HA fillers mostly dissolve with time, or can be reversed using hyalyronidase. It's crucial that filler HA fillers are reversed accurately before facial surgery as the repercussions of large volumes of filler left in the tissues can cause issues post-face lift. This is because the tissue manipulation during surgery can shift filler position, or that the trauma from surgery can cause fluid retention which then concentrates around filler sites (HA filler attracts water) and result in volume expansion and distortion. 
Currently, the most accurate method to map and reverse HA filler prior to surgery is with the use of ultrasound imaging. Experienced clinicians skilled with high resolution ultrasound scanning are able to map the distribution and depth of filler, and to reverse this with hyaluronidase under ultrasound guidance.
To summarise, HA fillers cause no issues whatsoever with future face lifts, providing that they are first dissolved prior to surgery for the reasons explained above. In my experience, the mid face region is the most important area for filler reversal as the tissues in this area undergoes significant manipulation during deep plane face lifts.

Leonard Grossman, MD · Answer

Your assumption is partly correct., But only Sculptra will form scar tissue in the face, which can possibly make a facelift dissection more difficult. Radiesse and hyaluronic acid fillers do not form any kind of scar tissue but instead can be encountered in the area of Surgery. My recommendation to you: if you require more fullness in the face, have fat grafting performed instead. Fat grafting almost never causes scar tissue. The results of fat grafting should be extraordinary in the right hands. And individuals who require a facelift in the future have nothing to fear as the facelift section is usually performed in such patience. I hope this helps and good luck from Leonard Grossman, M. D., organic Plastic Surgery in New York City.

Fillers make future facelift difficult, but are hyaluronic acid based fillers more acceptable?

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