By Dr. Philip Solomon and Nancie Heiber

Each treatment has its own purpose, and in some circumstances, the two approaches can be combined.  

At one time, average facelift patients were in their 60s; now the average age ranges from mid-40s to late-50s. Why the shift? Online access to information and celebrity lifestyles has stimulated demand, in addition to the desire to maintain a youthful appearance in the workforce as a younger demographic starts to swoop in. And a society focused on active, healthy lifestyles has created a desire in people to look as young as they feel. Now, many start to address signs of aging at an early age—as early as their 20s—with injectable treatments. These treatments are often effective in delaying the need for surgery for many years. But how will they impact surgery for those who decide to have a facelift later in life? Does filler complicate facelift surgery and its potential outcome? Dr.  Philip Solomon MD, FRCSC, Otolaryngology, Head and Neck Surgeon, practicing Facial Plastic Surgery in Toronto, discusses these two treatments. 

Dr. Solomon, let’s start with a definition and description of fillers. What are they and how are they used?

Dr. Philip Solomon: Filler injections have become one of the most common anti-aging treatments in the past 20 years.  The purpose of injecting dermal filler is to reduce facial folds and restore volume. The applications  for filler have become broadened over the years, giving rise to the term “liquid facelift.” This term can be misleading as it doesn’t clinically lift tissue (skin) but adds volume. The most common filler is made of HA (hyaluronic acid), a sugar-based molecule that can be dissolved. There are other  products that are longer lasting and have a different side effect profile; they must be injected by an experienced injector as it’s difficult to remove. In recent years, there are fillers that have been used as bio-stimulators that stimulate the body to produce collagen. Many surgeons have debated how these longer acting fillers can impact facelift surgery. I would say the general consensus is that temporary fillers have less of an impact on facelift surgery than the biostimulators. While biostimulators produce collagen, they can also produce scar tissue which can make surgery technically challenging. 

How do you know when to stop using filler and consider other treatment options? 

Dr. Philip Solomon: The overuse of filler can have negative consequences, commonly called “filler fatigue.” When patients have used too much filler over many years, they can develop a puffy appearance, including a squared-off lower third of the face, a bluish hue under the eyes and over-inflated lips. It’s essential that a provider uses a conservative approach to filler and encourages patients to have an open mind to alternative therapies, such as facelift surgery, when needed. 

Does the use of filler for many years affect facelift surgery in any way? 

Dr. Philip Solomon: We often see patients of 40 years and older who have had years of filler injections and now want facelift surgery to address the concerns that filler can’t address. However, they are concerned about whether their prior use of filler will impact their surgical outcome. It’s a terrific question, as specialists from across North America have varying opinions. In general, I like to dissolve the HA  fillers to better assess the facial anatomy which will allow me to be most artistic in my surgical approach. Dissolving of the filler is a simple office procedure but may require a few visits. If we determine the patient may still need added volume, we offer facial fat grafting commonly  with facelift surgery as it can be a very appealing option: a natural product with permanent  results. 

Is it common for facelift patients to still require filler or fat-grafting injections after their facelift surgery? 

Dr. Philip Solomon: Facelift surgery addresses many issues. However, it doesn’t always address everything, such as volume loss.  A facelift repositions the soft tissue and muscle vertically, undoing what gravity has done over the years, however there can still be some areas of the face that can benefit from filler or fat grafting to just give the facelift results an added wow factor. The temples, deep naso-labial folds,  lips and cheeks can often become quite depleted with aging. Filler or fat grafting can help restore volume loss while working in tandem with facelift surgery to provide a complete facial rejuvenation.