When it comes to facial rejuvenation, fillers and facelifts dominate the conversation. Both techniques offer unique advantages, but are far from interchangeable.
As pointed out in S05E98 episode of Three plastic surgeons and a microphonewith the participation of Dr. Sam JejurikarDr. Sam Rhee, Dr. Lawrence Tong and Dr. Salvatore Pacella, understanding the nuances between these processes is key for patients seeking the most natural, effective results.
“Fillers are awesome, facelifts are awesome, but fillers and facelifts may not always be so awesome,” said Dr. Sam Rhee at the start of the episode, summing up the complexities of choosing the right procedure. Fillers are ideal for younger patients with little volume loss and good skin elasticity, often providing quick, non-invasive improvements. Facelifts, however, address deeper structural issues such as sagging skin, making them more suitable for people with advanced signs of aging.
Dr. Lawrence Tong offered a critical distinction: “If you need a facelift, which means something is loosening in your face, then you will generally need surgery. Fillers usually just add bulk.” The misconception that fillers can replicate the lifting effects of a facelift often misleads patients, resulting in less than optimal results. For older patients with significant skin damage or sagging, investing in surgery it is often the most effective, long-term solution.
Challenges to excessive use of fillers
While fillers have revolutionized the beauty industry, their overuse has created unforeseen complications. Injectors without specialized training often rely heavily on fillers, sometimes distorting the natural anatomy of the patient’s face. “A lot of providers are not that honest,” warned Dr. Salvatore Pacella. “They’re just going to pump patients with fillers, even when they know it’s not going to help.”
Overuse can result in bulky, uneven areas and even permanent soft tissue scarring. According to a study published in the Aesthetic Surgery Journal Open Forum, 52% of surgeons reported difficulty performing facelifts in patients with a history of extensive filler use. “We’ve all had patients who come in looking like young aliens,” observed Dr. Jejurikar. “They may look young, but they don’t look human.”
The challenges extend beyond aesthetics. Scar tissue from excessive fillers can make future surgeries, such as a facelift, much more complicated. Dr. Jejurikar shared a vivid example: “I have done facelifts on patients and seen soft tissue filler ooze out like toothpaste. It’s very gross and shows how much distortion fillers can cause.”
To mitigate these risks, the podcast experts emphasized moderation. A limited amount of filler can effectively address specific areas such as marionette lines, lips or temples without overwhelming the natural contours of the face. However, as Dr. Jejurikar pointed out, many backs lack the training to know when to stop. “If your only tool is filler, you’ll use it for everything, even when it’s not appropriate,” he said.
Facelift Issues: Timing, Technique, and Alternatives
For patients whose aesthetic goals exceed what fillers can achieve, a facelift provides a more complete solution. A facelift not only removes excess skin, but also tightens the underlying facial structures, restoring a youthful appearance. However, for patients who have previously relied heavily on fillers, the road to surgery can be fraught with challenges.
“Scar tissue from fillers often complicates a facelift” noted Dr. Sam Jejurikar. “It distorts the soft tissue and creates additional obstacles for surgeons.” Preparation for surgery may involve dissolving the filler using enzymes such as hyaluronidase, but even this process is not without complications. As Dr. Lawrence Tong explained, “Hyaluronidase doesn’t always work because the filler is placed in so many layers, and some of them can be trapped by scar tissue.”
An alternative to bulking fillers is fat transfer, a procedure that uses the patient’s own fat to improve facial contours. “The beauty of fat gain is that it’s organic and predictable when done right,” Dr. Pacella said. However, fat transfer requires more downtime compared to fillers and involves a surgical component, making it a less attractive option for patients looking for a quick fix.
Dr. Rhee added that fat transfer is especially effective when done in conjunction with a facelift. “I almost never lift without including some fat transfer. It improves overall results and provides a more natural look.” For patients considering a facelift, surgeons stressed the importance of addressing both structural and volumetric issues to achieve a balanced, youthful result.
Finding the Right Provider: What Patients Need to Know
Choosing the right practitioner is critical, whether for fillers or surgery. Patients need to ensure that their injector or surgeon is not only suitable but also aligned with their aesthetic goals. “If you walk into a practice and see that the staff or the infusion device itself looks unnatural, that’s a red flag,” Dr. Tong warned. “If you don’t like their looks, why trust them with your face?”
Dr. Jejurikar echoed that sentiment, urging patients to choose providers who prioritize natural appearance over exaggerated enhancements. “Ultimately, we’re trying to restore what’s been lost, not create a distorted or fake appearance,” he explained. Patients should also be wary of injectables who do not have the ability to refer them to surgeons for more advanced treatments. As pointed out by Dr. Rhee, “If your injector is not related to a surgeon, it’s a sign that they may be relying too much on fillers to solve problems that require surgery.”
When deciding between fillers and facelifts, consult a board certified plastic surgeon she is invaluable. Surgeons can assess the patient’s facial structure, skin quality, and aging concerns to recommend the most appropriate course of action. “Each patient is unique,” emphasized Dr. Jejurikar. “It’s not about fillers versus facelifts – it’s about finding the right solution for the individual.”
Wrapping it up
The interplay between fillers and facelifts is complex, and the decision to pursue one over the other depends on factors such as age, skin quality, and personal goals. While fillers offer a quick and non-invasive option for younger patients, they can only go so far. For patients experiencing significant sagging or structural concerns, the facelift remains the gold standard.
The key takeaway from Three Plastic Surgeons and a Microphone is the importance of balance and expertise. Whether considering fillers or a facelift, patients should look for providers who prioritize natural, personalized results. As Dr. Jejurikar aptly put it, “We don’t just improve appearance – we restore confidence, one face at a time.”
