“Facelift or filler, What do you think Dr. K?”
Facelift or filler, seems like an easy question. For the moment we will not address brow lifts and eyelid lifts. But the process to get the answer is fairly complicated. As always it goes back to your anatomy. If you look at your face there are many ways to diagram it or separate the parts. One way is by skin adherence and mobility. Around the mouth skin is adherent to the muscle, there isn’t much fat and there’s a lot of emotion in this area. The rest of the face, cheek, jowels, and neck have a layer of fat between the skin and muscle and less adherence with less motion when we eat, talk or laugh. But it does have more of a tendency to sag as we get older. In addition one of the unfortunate aspects of aging for many people is a loss of facial fat. No one really knows why it goes away. It just does. It seems to be related to declining hormone levels but all that still needs to be worked out. Look at the photos of people in college, in mid life, and then when their old. The loss of fat, the gaunt look is quite striking. As an easy visual, think of Al Pacino in the Godfather and then again in his latest movie.
So we have two areas of the face by these criteria. The central area just above and below the lips creates wrinkles from use and the lips themselves shrink. Does lifting and pulling help any of this? No. What’s worse an ill-advised attempt at improving the lips by pulling (face lift) gives the widened stretched lizard lips sometimes seen in aging movie stars on late-night talk shows. Lipstick lines, nasolabial folds, and the lips themselves are perfect for fillers which plump up and spackled these lines. One exception to this rule is the tear trough area just under the eyes which can present as a darker circle but not a bank or a bulge but a hollow. This area also responds very well to fillers.
On the other hand if there are jowls, multiple cheek wrinkles, and heavy nasolabial folds and neck issues, fat, hanging skin, muscle bands, then a facelift is the only way to go. Fillers may help slightly with the nasolabial folds but by themselves cannot lift the jowls and neck.
Now that we know what a filler does, what is it? There are many different kinds ranging from collagen to silicon to fat. The most commonly used ones now are hyaluronic acid such as Juvederm and Restylane. This is a natural component of our skin and was formerly obtained from rooster combs but is now available by being made by bacteria. This substance which looks like a clear jelly is injected through a small syringe with a very small needle. Depending upon the area, this can be done with no anesthesia, topical anesthesia or nerve blocks like a dentist.
Facelift or filler? Look at the mirror what do you see? Then see if your doctor agrees.
