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

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

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—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.