Should cheek and lip injections be dissolved before a SMAS face lift?

Question

I had Voluma injected approximately 6 months ago. (2 syringes). I've decided to just go ahead and do a SMAS facelift. I've had consults with two surgeons that have been in the business for a while and they said that there is no need to dissolve injections. My 3rd consult was with a much younger surgeon who has a lot less time in the field but he only does facial work. His response was to dissolve the injections in order to see the natural face before performing the lift. I'm not sure what to do.

Amir Nakhdjevani, MBBS, MRCS, FRCS(Plast) · Answer

I would advise there is no need to dissolve the filler. As t is was done 6 months ago it will not be as noticeable and will not make any difference to the outcome post Facelift surgery. All the best

Jonathan Kulbersh, MD · Answer

There is no need to dissolve your fillers before your rhytidectomy (facelift). While Voluma can do an excellent job of filling out the midface, two syringes does not make a difference significant enough that it would affect how your facelift is performed or influence the final results. The lip fillers will not affect surgery at all, either. I hope this helps.

Ronald Schuster, MD · Answer

I do not think that hyaluronic acid fillers like Restylane and Juvederm need to be dissolved prior to surgery. Most experienced facelift surgeons should be able to "guesstimate" the amount of volume that is being added by the filler. This is assuming that the fillers have not been over done. Different facelift techniques can change the volume in different parts of the face and this can be taken into consideration by the surgeon. It is important to tell your surgeon if you have fillers to discuss your options.

Andrew P. Trussler, MD · Answer

Voluma is a hyaluronic acid filler that is long lasting and typically injected in the deeper facial plane. Voluma is typically injected in the deeper plane of cheek and midface and there would be no need to dissolve it prior to a facelift as it will dissolve over time and its effect will have no bearing on facelift planning.The term SMAS facelift really tells me nothing. The main question would be how far the SMAS is mobilized and in what plane. There are so many SMAS facelift techniques with the majority not having any effect on the cheek. A high SMAS will mobilize the cheek but should be more superficial that the Voluma and the SMAS will move over the filler. Voluma is hard to dissolve anyways. Good luck with your facelift

Mark Anton, MD, FACS · Answer

Hello Shawn-Volume augmentation is often placed in areas that a facelift is not going to change a lot or in places that would just enhance the facelift changes. In general, I would not dissolve the Volume and proceed with your plan.Good luck.

Reza Nassab, FRCS (Plast) · Answer

You do not need to dissolve the fillers prior to your procedure.  Voluma is a temporary filler and the amount used 6 months ago is unlikely to have a significant impact on the final outcome of your surgery.

Inessa Fishman, MD · Answer

Voluma is a filler typically placed deep in the cheeks, just above the bone--in a tissue plane similar to a cheek implant.  This area does not typically undergo dissection in a SMAS facelift.  Moreover, 2 syringes of Voluma injected 6 months ago should not have a significant impact, volume-wise, on the planning or intraoperative details of facial rejuvenation surgery.  I would not recommend dissolving the previously placed filler.  Good luck with your treatment!

William Portuese, MD · Answer

There is no reason to dissolve the temporary filler injections in the lips or the face prior to a facelift procedure.  Choose your facelift surgeon based on extensive experience producing natural results consistently.

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed facelifts for over 30 years and have performed many minimally, invasive type facelifts.  Non smiling photos of your face from the front and side would help in the evaluation.  Whether the face has been injected with an HA filler (like Voluma), a permanent filler, fat transfer or nothing previously...I evaluate the "current shape of the face" as that's what's going to be modified, shaped and rejuvenated during the facelift procedure as described below.  If the dermal filler has created the proper aesthetically shaped cheeks, there's no immediate reason to get rid of it.  I personally don't like or use Voluma to shape the face (cheeks, chin or jaw line) but that's my humble opinion.  I prefer using Restylane Lift which seems to have far less inflammatory issues with its use....so from that standpoint, I typically do suggest removal of Voluma prior or during the facelift procedure.  
 Following my beauty principles developed over the past 30 years, women look the most feminine, youthful and attractive with heart shaped faces which all have cheeks that are full and round in the front.  If your cheeks are flat in the from they can be shaped with a Cheek augmentation using a dermal filler or by using cheek implants (for a permanent enhancement) to create full, round cheeks that will feminize the entire face.
 A weak chin 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.
 If you have "jowls” these 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 and no incisions extend or are placed within the hair.
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.

Should cheek and lip injections be dissolved before a SMAS face lift?

Answers (9)

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