With the rise of biostimulators and energy-based treatments, facelift surgery is no longer a standalone solution but part of a more layered approach to facial rejuvenation.
By Dr. Philip Solomon and Nancie Heiber
As the conversation around facial rejuvenation continues to evolve, there’s a growing shift away from one-size-fits-all solutions and toward more tailored, long-term strategies. While facelift surgery remains the gold standard for addressing deeper structural changes, treatments utilizing biostimulators and advanced energy-based devices are increasingly shaping how patients maintain and enhance their appearance over time. Rather than replacing surgery, these technologies are being used to improve skin quality, support collagen production, and extend the longevity of both surgical and non-surgical outcomes. Dr. Philip Solomon, MD, FRCSC, Otolaryngology, Head and Neck Surgeon, practising Facial Plastic Surgery in Toronto, explains how these treatments are being used independently and in conjunction with facelift procedures.
There’s been a lot of buzz in the industry around biostimulators and energy-based devices. What’s driving that conversation right now?
The dialogue about biostimulators and energy-based devices has evolved online amongst some surgeons and dermatologists who have been discussing the pros and cons of utilizing biostimulators and energy devices before and after facelift surgery. Some of the dermatologists were big proponents of their use, indicating they should not affect surgery. However, some surgeons felt that the use of these treatments made surgery more complex and risky.
In our practice, we offer both biostimulators and energy devices, pre- and post-surgery. If the patient’s plan is to have a facelift within the calendar year, we recommend not utilizing these treatments, as they can influence tissue quality by introducing elements such as fibrosis, altered vascularity, and less distinct dissection planes. These variables can be effectively managed by an experienced facelift surgeon.
Biostimulators are often described differently from traditional fillers. How do they actually work, and what sets them apart in terms of results?
Biostimulators work by activating fibroblasts—the cells responsible for producing collagen and elastin—while also supporting the remodelling of the skin’s extracellular matrix. This process, often referred to as bio-regeneration, strengthens the skin’s underlying structure over time.
Unlike traditional fillers, which provide immediate volume, biostimulators work by building collagen. Patients will see improvements in skin thickness, firmness, and elasticity rather than a sudden change in contour or volume. The result tends to be more subtle and natural, as it’s driven by your body’s own collagen production.
Energy-based devices are another major part of this shift. What do they specifically improve when it comes to the skin that injectables alone cannot?
Energy-based devices work in a fundamentally different way than injectables. Technologies such as radiofrequency, ultrasound, and certain laser systems deliver controlled energy at specific depths in the skin, leading to collagen denaturation and subsequent neocollagenesis—the formation of new collagen over time. This process improves skin tightness, texture, and overall tone. While injectables primarily restore volume and contour within the tissue, energy-based devices enhance the skin’s surface integrity and firmness, making the two approaches highly complementary.
For someone considering surgical facial rejuvenation today, how should they think about the timing of non-surgical treatments?
I advise patients to think of facial rejuvenation as a continuum. In the earlier stages, I often employ non-surgical modalities to preserve skin quality and subtly delay visible aging. Biostimulators can be integrated into a treatment plan starting in the late 30s and 40s, if surgery is planned for the late 40s and 50s.
As structural changes emerge—particularly laxity and loss of contour—surgery becomes the more appropriate and definitive step. Some surgeons recommend avoiding biostimulators for 12 to 24 months prior to facelift surgery. When timed judiciously, these approaches complement one another, allowing for results that are both natural and enduring. The key is understanding that they are not mutually exclusive. When used at the right time and in the right combination, they can work together to create long-lasting results.
Facelift surgery is still considered the gold standard for structural change. What is it able to achieve that non-surgical treatments cannot?
Facelift surgery remains the gold standard for structural rejuvenation. The deep plane facelift, which I have been using in my practice for over 10 years, allows me to address the underlying anatomy by repositioning deep fat compartments and refining the SMAS layer to restore natural contours and address laxity.
Non-surgical treatments, while valuable, are inherently limited to the skin and more superficial tissues. They can enhance skin quality and provide modest tightening, but they cannot replicate the degree of structural repositioning achieved surgically. For patients with more advanced aging changes, surgery offers a level of precision and durability that non-invasive approaches simply cannot match.
How are you seeing biostimulators and energy-based devices used alongside facelift procedures today?
These treatments are increasingly being used to complement surgical results rather than replace them. Facelift surgery is essential for repositioning deeper structures of the face, but it does not directly improve the quality of the skin itself. That’s where treatments such as biostimulators and energy-based devices come in. They refine the skin’s texture and resilience, elevating the final result in a way surgery alone cannot. Lasers also contribute to improving skin quality and tautness, utilizing ablative and non-ablative technology to address fine lines, wrinkles, and pigment.
When multiple modalities are used together, the outcome can be greatly enhanced, providing a more refreshed and natural result.
How are these treatments used before and after a facelift to enhance and maintain results?
Before surgery, these treatments can be used to optimize the skin. Energy-based devices can improve elasticity and stimulate collagen production, while biostimulators can enhance dermal thickness and overall skin quality.
After a facelift, they play an important role in maintenance. By continuing to support the skin’s structure, they can help extend the longevity of surgical results and keep the skin looking healthy over time. It’s a more comprehensive, long-term approach to facial rejuvenation.
Choosing a practice that offers the full range of these options, including surgery, ensures that your treatment plan is thoughtfully tailored rather than limited by a single modality. Surgical intervention remains the foundation of facial rejuvenation, with non-surgical treatments serving as essential complements for optimal outcomes.
May 01st 2026