I am a youthful 56-year-old female. Should I have a facelift or Bellafill?

My local plastic surgeon says to do the facelift and a filler doctor told me to go with Bellafill. I am concerned about my neck, loss of volume in cheeks, and eyelids. I was under the impression to have a facelift, all filler should be gone from face for best result and the Bellafill is permanent. What if I have the Bellafill and want facelift in future? Or would the Bellafill remove the need to have surgery? What do you recommend for someone my age?

Doctor Answers 4

Bellafill / ArteFill vs facelift - my experience over 20 years of plastic surgery practice

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This will not be a popular post, but somebody has to tell patients their experience treating patients with permanent fillers.

I was not a fan of ArteColl or ArteFill, and am not a fan of BellaFill, an identical product with a different name.  Google ArteFill complications to see the experience of patients who have had ArteFill long term.  I believe the PMMA beads can migrate, usually downward.  Ernie Klein had the best explanation for this, muscular activity causing forcible shift in position of the beads.  I personally believe that ArteFill caused problems with the areas of collection, above the mandibular and nasolabial and cheek septae, resulting in an inflammatory reaction occurring with no place to drain properly, causing chronic edema and unusual swelling.

Most plastic surgeons who have been in practice for many years have seen the results of ArteFill causing chronic, untreatable inflammation and migration downward to produce sometimes alarming, silicone-like results in the face.  The immediate results are quite nice, but it is the results 5-10 years later that are disturbing when the biologic process runs its course.

PMMA beads, even larger ones, can develop a biofilm around them.  They have no blood supply to protect against the opportunistic organisms which are everywhere in the blood stream and face.

I personally believe the increase in volume seen over time with ArteFill and BellaFIll is due to an inflammatory reaction of granuloma formation or biofilm, not to a beneficial 'collagen production' as its proponents contend.

I stand by my posts from the past in which I have urged patients to avoid permanent fillers such as silicone, once popular and now vilified, PMMA, and ArteFill / Bellafill.

A well done facelift leaves minimal to no trace, rejuvenates permanently, and can always be augmented with either long lasting hyaluronic filler, which seldom causes trouble, or Radiesse, which I have never seen cause a chronic inflammatory reaction the way silicone or ArteFill can.  For patients not ready for surgery, those fillers provide very nice, safe augmentation.

I have never injected ArteColl, ArteFill or silicone in any of my patients, and will not do so in the future, no matter how the products are renamed, marketed, and produce revenue for doctors using them.  

I will continue to treat the complications of silicone, ArteColl, ArteFill, renamed BellaFill, provided that patients have realistic expectations and realize that the problems resulting from injection of these permanent substances cannot be cured, only improved.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 191 reviews

Facelift or Bellafill for 56 year old?

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Photos or an examination of you would really be helpful to give you the best advice to decide between a facelift versus Bellafill.  In general, a facelift and Bellafill do different things.  Bellafill adds volume to the face while a facelift deals with lifting and tightening of the skin.  Sometimes adding volume may be better for one person while a facelift might be better for someone else.  At times, both procedures may give the best result.  If you had Bellafill first, this should not prevent you from having a facelift in the future.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

Facelift Versus Fillers

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Facelifts often NEED fillers like Bellafill or fat injections to give improvement in both volume and lifting.  I suggest a formal consultation with someone who is an expert in facial sculpting, as it is likely that you need both lifting and voulme as well as textural improvements.  All this can be done at the same time -- surgery, laser, fillers/fat.  Long term fillers and lasers will be used to maintain your skin and the lifting that you get from surgery.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 204 reviews

Bellafill or Facelft? Why Not Both?

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Great question that exposes a problem that we see regularly. If you go to a surgeon who does not do fillers, you will be offered a facelift. If you see a filler doctor they will only offer fillers since that is all they have.

In general, facelifts are best at addressing your neck, your jaw line, jowls and the wrinkles of your cheeks. Fillers do a good job around your mouth including your lips, the nasolabial folds and marionette lines. I will often offer or suggest both to patients to get a good overall correction of a patient's signs of aging. Your provider should tailor your treatment to address all of your needs and goals.

I have added a video that addresses all of this.

I hope that helps.

Best regards.

Brian Windle, MD
Kirkland Plastic Surgeon
4.9 out of 5 stars 66 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.