I'm doing a facelift and Sculptra, which is better to do first?

Replace the volume loss AFTER. That way you get it put in the correct place, in the right amount, after the facelift puts the majority of tissues back where they came from. Sounds like you’ve got 2/3 of the plan figured out; facelift to put the tissues back where gravity dragged them down from, Sculptra or fat to replace the volume lost from aging, and what’s left is treatment of the effects of sun damage on the skin, ie, resurfacing of some type, be it laser, chemical peeling, radio frequency energy.
The garnish on that plan would be use of neuromodulators like Jeuveau, etc for any muscle wrinkles if required.

Yours is a good question. Your comment about faces sagging as well as shrinking is exactly correct. And there are multiple good options as far as timing. To answer your question specifically, photos would be required. A good analogy is you can drive from one one town to another by different routes, and still arrive safely.  But the best route depends on traffic, etc. 
There are some important distinctions between the modalities. I do a lot of Sculptra as well as fat grafting. Both options work far better and more economically than fillers (one cc at a time) for restoring lost facial volume.  With Sculptra, most of us National Trainers feel like each vial yields roughly 4-5 cc of collagen synthesis. With fat, we put between 40 and 60 cc.  Yield is estimated at 75-85%.  So, if you need just a little volume, Sculptra can be injected in an outpatient setting. It can be done before, during, or after the lift.  Your surgeon should give you his or her best estimate on how many vials, what areas would be treated, etc. Whereas high volume fat grafting requires sedation.  It is rare that we do a facelift that does not include fat grafting. That is the ideal time to avoid two recoveries and two OR fees.  
One caveat is that you are a bit on the young side for fat grafting.  As people age, menopause and orthopedic issues can sometimes result in weight gain later in life.  Fat which is grafted tends to behave as it would have if it remained in its donor site.  So I would tend to be a bit conservative in terms of volume of fat transferred and realistic about your future weight management.

My recommendation would be to have a facelift first, and then have the Sculptra treatments after everything has healed.  Both procedures can help to rejuvenate the face in different ways and they frequently can compliment each other.  For some people who do not have a lot of skin sagging, Sculptra by itself can provide enough benefit so that a facelift can be postponed until further aging has occurred.  

Very good question. These two procedures are very compatible, since Sculptra or fat transfer restore youthful volume to the face to put the finishing touches on your anti-aging efforts. Fat transfer can often be performed during the facelift. If you opt for Sculptra, your best bet is to wait until you are fully healed from your surgery to undergo Sculptra injections. Keep in mind Sculptra takes a few months to take full effect, but at that point the results are long-lasting. Fat transfer results will be apparent right away and will continue to improve in the weeks following your treatment. Many patients find fat transfer provides permanent improvement. Make sure you work with an experienced, board-certified plastic surgeon and follow your doctor’s recommendations as you pursue all your aesthetic goals. 

Thank you for your question! I would recommend fat transfer at the same time as your facelift so you can restore volume to particular areas of the face. An added bonus is that you won't have to go through an additional recovery period. Sculptra can take multiple treatments and months to see the final result which is less than ideal. You are probably better off from a cost and result standpoint, to go with fat grafting. Hope that helps!

Mahalo Aloha!  If you are committed to having a face lift surgery then I would suggest having facial micro and nano fat grafting at the time of the face lift surgery.  You will have only one recovery period and minimal discomfort.  If you are committed to Sculptra then I would wait until after you have had your face lift as there is a chance that the Sculptra will displace during the face lift surgery and result in subcutaneous distortions.

It can be recommended to have the facelift first then have the fillers. Alternatively, facelifts can be and are often combined with facial fat grafting to restore volume loss in the face and improve proportions and contours. This can be a better option depending on the case. It is best to talk to and have your operation customized for your case by your board certified facial plastic surgeon.Hope this helps,Ali Rıza Öreroğlu, MD FEBOPRASEuropean and Turkish Board Certified Aesthetic, Plastic and Reconstructive SurgeonIstanbul, Turkey

Balancing volume loss with tightening of loose skin is really the art of rejuvenation procedures.  This requires a careful eye to determine what is needed, where, and how the dynamics of expression may change your image.  Know that Sculptra achieves volume by stimulating inflammation as the foreign material product will trigger collagen production in the injected sites.  The product and collagen will eventually breakdown as your tissues bring macrophages and lysosomal enzymes to these sites.  Fat transfer has the potential for apoptosis and is a more delicate process in attempting to maintain oxygenation and nutrition to the fragile cells that need to be in close proximity to vascular capillary beds.  Those fat cells that do survive will provide natural cellular volume for the long term.  Once volume is balanced, structural lifting and excess skin resection is then performed, often at the same procedure, so timing and sequence should be carefully planned.  Ask your board certified plastic surgeon about his or her specific strategies before committing.

Aloha and thanks for your question. Fat transfer can usually be done at the same time as a Facelift. Sculptra or other fillers can be added later, if necessary. I would recommend you see an experienced Surgeon Certified by The American Board Of Plastic Surgery[ABPS] and a member of The American Society of Plastic Surgeons (ASPS). Mahalo, Dr D

This is something to discuss with your board certified plastic surgeon. For my patients, in many cases I do fat transfer at the time of facelift surgery. Good luck.