What imaging should be done to evaluate old fillers before facelift procedure?

Question

Hi, I hadve old fillers, including silicone ( without any problems) for a long time and im considering a face lift. What imaging should I consider ( MRi ultrasound) to help figure out what procedures deep plane, smas would be approptiate or not possible

Gianfranco Frojo, MD · Answer

MRI with targeted identification of soft tissue fillers and/or high resolution utlrasound. I perform the ultrasound in office as part of all facelift consults if the patient informs me of lots of previous filler use. I prefer to also dissolve the filler 8 weeks prior to surgery.

Stephen Prendiville, MD · Answer

Thank you for your question.  These days, the majority of my facelift patients have had fillers at some point in the last 15-20 years.  There is no specific imaging that is necessary or really helpful prior to a facelift.  Sometimes it is advisable to have fillers dissolved, but not always. The best thing you can do is describe previous procedures that you have had done and allow your Surgeon to evaluate your suitability for surgical intervention.

Arthur Dean Jabs, MD, PhD, FACS · Answer

Hard to answer without performing an in person examination. 
The depth of the filler, especially silicone, affects how this is approached. I don't think imaging plays much of a role in this. If the filler is deep, you may encounter it more with a deep plane lift but it may be distorted more with a SMAS lift that requires plication of the soft tissue. 
The HA fillers should have dissolved if they were placed many months or years ago. It is the silicone that  is the wild card so to speak.
Be sure to bring this up to your surgeon before proceeding and trust their evalualtion once they have had a chance to examine you.

Thanks for the question

Dr. Jabs

Lucian Ion, FRCS · Answer

Thank you for your enquiry. In general terms, an MRI scan with contrast—ideally discussed in advance between your surgeon and the radiologist performing the investigation—can provide a more detailed assessment of the distribution of filler within the facial tissues. This allows for clearer mapping and may also be used to generate a three-dimensional representation of the face showing the location of the filler, which can help guide more precise, targeted treatment when removal is being considered.

Ultrasound can also be used, particularly to guide injections of hyaluronidase under direct visual control, which in itself can be advantageous. However, this approach can sometimes complicate the overall assessment and treatment strategy, depending on the clinical situation.

Ultrasound can also be used, particularly to guide injections of hyaluronidase under direct visual control, which in itself can be advantageous. However, this approach can sometimes complicate the overall assessment and treatment strategy, depending on the clinical situation.

Emre Guvercin, MD, FEBOPRAS · Answer

In patients with a history of old fillers&mdash;especially permanent fillers like silicone&mdash;preoperative imaging is very helpful before deciding between deep plane, SMAS, or other facelift techniques.High-resolution ultrasound is usually the first and most practical choice. It can identify:Filler location (superficial vs deep)Nodules, granulomas, fibrosisRelationship to SMAS and subcutaneous planesThis directly helps determine whether deep-plane dissection is safe or should be modified.MRI can be useful as a complement in selected cases, particularly when:There is extensive or unclear silicone migrationDeeper tissue involvement is suspectedPrior complications or inflammation are a concernMRI gives a broader anatomical overview but is less precise than ultrasound for exact surgical planes.

Williams Bukret, MD · Answer

Hi, thank you for your question.

When a patient has a long history of facial fillers, especially older or permanent materials such as silicone, the first step is to understand where the material is located, how deep it is, and whether it is causing distortion, inflammation, nodules, or changes in the normal tissue planes.

High-frequency ultrasound with Doppler can be very useful for evaluating facial filler material because it may help identify location, depth, vascular relationship, and filler-related complications. In selected cases, MRI may also be considered, especially when deeper tissue involvement, unclear anatomy, or permanent filler material is suspected.

For facelift planning, the key question is not only which imaging test to obtain. The real question is how much of the facial change is true soft-tissue descent, how much is filler-related distortion, and whether surgery can be performed safely around altered tissue planes.

Old fillers do not automatically rule out facelift surgery, but they can change the planning. Silicone and other permanent materials may not always be safely or completely removable, and the surgical approach should be conservative and anatomy-based.

A structured virtual consultation or online facial evaluation can be a reasonable first step to review your photos, filler history, symptoms, and goals. The final plan should be based on a complete facial analysis and, when appropriate, imaging reviewed with the surgeon and an experienced radiologist.

Best regards,  
Williams Bukret, MD  
Plastic Surgeon

What imaging should be done to evaluate old fillers before facelift procedure?

Answers (6)

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