Are fillers necessary after a facelift?
The answer is maybe, according to the patient’s problem and expectations. A facelift will restore some of the lost volume by rearranging the volumes in the face. The jowl, for instance, came from an area above the jowl. If this is moved in an upward direction, it will help fill the mid-cheek area, which does become deficient in the aging face. The cheek (“bone”) also acquires more volume in a properly performed facelift accompanied with a midface lift, and volume is needed there as well. Another area that benefits from increased volume following a face and midface lift is the hollowed area under the lower eyelids. This is one of the first areas that reflect the aging face.
This leads us to the additional question of whether the above mentioned increased in volume are adequate following a facelift. If the patient is thin, then more volume is generally needed to achieve an adequately youthful facial shape. You may notice that young faces have very minimal shadows, hollows and concavities in their faces, and the cheek is round. The cheek also fills the area toward the nose and lower eyelid and extends downward almost to the level of the upper lip. The volumes in areas of deficiency in the aging face can be helped with a facelift and midface lift, but often not enough. If his is the case, a filler of some kind may be indicated.
Most facelifts are accompanied with fat transfer (fat grafts) during the procedure, which can be very helpful providing the fat survives. Because of the inconsistency of fat transfer during facelifts, the fat transfer may need to be repeated. Or, another product may be used at a later date to increase the volume. Acceptable fillers as alternatives to fat transfer are Sculptra, Juvederm, Restylane, and Artefill in my practice.
Of course, in this discussion, we are referring to efforts to achieve the very best in turning back the clock in one’s appearance. Many people are elated with the facelift alone. As always and as it should be, the final decision is up to the patient.
E.Ronald Finger, MD, FACS