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?

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.

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

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