Hi 301Linda,Without seeing photos and speaking directly with you to listen to your goals for improvement and showing you in a mirror what the facelift will do, it would be difficult to predict whether or not you would still "want" filler injections after the facelift. A facelift/necklift will improve sagging of the neck, jawline and lower cheeks. If you have marionette lines, which are the vertical lines going down from the corners of the mouth, these tend to improve greatly with a standard lower face and necklift. As for the smile lines which go from the corner of the nose to the mouth, also known as nasolabial folds, in general, there is much less improvement in this area with a facelift. If there is any improvement in the nasolabial fold, after reviewing hundreds of before and after photos, the improvement is mainly in the lower one third of the smile line, but the upper two thirds of the smile line does not appear to have much improvement in the depth of the line.With a facelift, the midface or upper cheeks are often lifted together with the lower facelift/lower cheeks, but even then, deep smile lines appear to keep the same depth even though the cheek fat pad appears lifted. In these, cases injectable dermal fillers seem to complement the results of the facelift.If a surgeon promises that you will no longer need fillers if you simply have a facelift, it is very easy to check this in their before and after photo gallery. Simply review their before and after photos looking specifically at the marionette lines and smile lines, and see if you were the patient would you want some additional filler injections to smooth out those lines even further.If a patient really would benefit from a face and necklift with sagging jawline (jowls) and sagging cheeks that fold over the marionette lines and nasolabial folds, using only one treatment such as injectable fillers only or a facelift only will unlikely give a fully satisfying result. In the case of using injectable fillers only, the actual wrinkle may be filled, if you look closely at the line, but because the tissues of the cheek are hanging over the filled line, the overall result still doesn't look right. It can look strange if the smile lines and marionette lines look filled in yet, the patient still has significant sagging around the lower cheeks and jawline.If the surgeon doesn't believe in fillers, and performs a very tight facelift to try to avoid using fillers, then this might give an overly tight appearance and in some cases the corners of the mouth widen, which is not a good look either (wind swept appearance.)Trying to do too much with only one type of treatment can begin to give away that some "work" was done. In the case of fillers, there is a phenomenon called "pillow face" where the patient looks puffy in areas, from overfilling. In those, cases, no matter how much filler you use, the "sagging" tissues can't be lifted upwards and have the excess skin tailored out for a slim, trim appearance like a finely tailored suit. Once the cheeks and jawline are lifted, if the marionette lines and nasolabial folds still have a wrinkle, usually the depth of the wrinkle is much shallower and would not require as much filler as a patient who did not already have a facelift. Since the majority of the sagging is improved, the shallower line can be filled without looking puffy. If the patient is not opposed to having repeat injections, I will either use Restylane, Juvederm, or Radiesse, to soften and try to smooth out the marionette lines and nasolabial folds as much as possible. If the patient would like a more permanent filler, I use Artefill which is an FDA approved permanent filler for the nasolabial folds. This way the patient can have an improvement in those lines which match the facelift. As the face ages, even though the Artefill is permanent, the lines may deepen even though the filler is not diminishing from the natural aging process.If you would like to see an example of a 70 year old woman which I treated with a lower face and necklift, please follow the Web reference link below this response. In addition to the facelift, I used Artefill for the smile lines and marionette "shadows" which were remaining. Additionally, I used Restylane to smooth the lower eyelid bag (on the right side) and left tear trough (dark circle) to help blend the cheek and lower eyelid together for a more seemless cheek to lower eyelid transition. Currently, I am not comfortable using a permanent filler such as Artefill for the lower eyelids, for risk of lumping. Since Restylane appears to last about 12-18 months in the lower eyelid area, maintaining the improvement does not require my patients to come in every 4-6 months as with Restylane in the smile lines or 9-12 month for Juvederm in the smile lines, and Radiesse appears to be 12-15 months.For my younger patients around 50 and below, often times, they do not really have a true marionette line, and I like to call it their marionette "shadow". In these patients' cases, they really don't ask for filler in this area or the nasolabial folds after the facelift. In patients over 60, they are more likely to ask for filler even after the facelift. If you are aging well as with my 70 year old example patient, you may opt for filler or not. In her case, I only used a single syringe of Artefill, and you can see there is still some residual smile line left over, but we felt that to completely eliminate the smile line with a second syringe of Artefill for a 70 year old woman did not make sense, and leaving some lines actually made her look more natural, since all of her friends are the same age. Best,Dr. YangP.S. There is a new feature on Realself, which is the "Follow" button. It is similar to the "Like" button on Facebook. If you like my response or any of the doctor responses while you research on Realself, you should "Follow" them. You will get email updates, when the doctors you follow post any new answers to questions, post new photos, or have any new reviews.
