Should I dissolve dermal fillers in my face before facelift surgery?

Is it important to remove dermal filler before facelift surgery?

Dr David Sharp

Specialist Plastic Surgeon + Registered Medical Practitioner

Article written by Director and Journalist Liz Washington B.Journ, and medically reviewed by Dr. David Sharp, MBBS, FRACS (Plast)

TGA regulated injectable medicines are placed in the face via needle or cannula treatments to increase volume, mimic bone structure and provide facial projection. They are most commonly employed to reduce the appearance of fine lines, wrinkles, and to restore lost volume to areas such as the cheeks, lips, and under-eye hollows.These products usually dissolve over time, as the body metabolises the natural substances that they are made from.

Patients considering facelift surgery often ask us whether they need to dissolve their filler prior to surgery. There is no one-size fits all answer to this question, as it will depend upon how much filler has been placed, and where the filler is located.

Most commonly, we come across this question when patients have recently had a filler treatment in their mid or lower face (cheeks, jawline or lips).

They may find that while it has increased their facial volume in these areas, the filler has not tightened the skin in the mid and lower face, jowls or upper neck, which is why they might then seek facelift surgery.

Provided the area has not been over-filled, usually areas such as the lips, temples and mid cheek do not require dissolving.

However, often, high volumes of filler have recently been placed, and this can obstruct the patient’s own anatomy. But the filler could also be unexpectedly old.

Dr Sharp plastic surgeon planning facelift

Research also shows that filler may be present in tissue for much longer than expected. In our experience, this is more common in the tear trough (under eye), temporal and jaw areas.

MRI investigations have identified filler migration and longevity varies between products and injecting location.

Dr Sharp occasionally finds deposits of dermal filler extruding from sections of the face while performing facelift surgery, in areas where patients have reported having fillers placed 3-4 years prior. This does not result in an adverse outcome for the patient, but highlights that we may not know how long after filler treatment our facial appearance continues to be altered.

Should I have my filler dissolved before my facelift consult?

Dr Sharp does not recommend dissolving filler before your initial facelift consultation with him.

During the initial consultation, Dr Sharp conducts a thorough examination of the face and is able to see, and palpate, filler – distinguishing it from the patient’s natural tissue. If he determines that facelift surgery is suitable, and the dermal filler is obscuring the patient’s natural facial anatomy, proportions, contours and skin laxity, he will ask them to dissolve the filler before their next preoperative consultation with him. This can be performed by our plastic surgery nurses or any doctor-led cosmetic injectables clinic near you.

At the second preoperative consultation, clinical photos will be taken to record your facial anatomy ‘baseline’ and Dr Sharp will perform a second, accurate, assessment of your face for surgical planning purposes.

It is important to note that not every patient who has filler will need to have it all dissolved before surgery. Considering the cost of filler treatments, prematurely dissolving filler could be an unnecessary waste of the money they have invested in previous filler treatments.

Also, not every patient that has a facelift consult will proceed with surgery! Sometimes, patients choose not to proceed once the recovery, risks or costs of the procedure are considered in more detail during the consultation process. Dissolving filler prior to the consult could then mean it has been removed for no reason, again at a financial cost.

How long before my facelift surgery should I have my filler dissolved?

If Dr Sharp has indicated that you need to have filler dissolved, he recommends leaving as much time as possible between dissolving and having surgery. This is because the TGA regulated drug that is used to dissolve filler can also diminish the levels of naturally-occurring hyaluronic acid in the dermis. If you are otherwise healthy and do not have underlying health conditions, this is usually temporary and the skin restores its hyaluronic acid levels in the months after dissolving. We recommend getting your skin into its best possible shape before heading into facelift surgery, as this will aid the healing process, which means having your filler dissolved as soon as possible once you have made the decision to proceed with surgery.

My surgeon has told me that I need to dissolve my filler, but what could happen if I don’t do it before my facelift surgery?

Your face is filled with a network of drainage points, known as lymphatic nodes. They help blood flow and eliminate swelling in the face. However, large amounts of fillers, when placed adjacent to the nodes, can cause lymphatic congestion, or poor drainage of the fluid in the face. Lymphatic function is an important part of healing after surgery and so patients with filler in their tissue may feel that swelling takes longer to dissipate after surgery, which can result in slower healing.

It is also important to note that the fillers commonly used in Australia are hydrophilic, meaning they absorb fluid and expand after placement – so the significant facial swelling experienced after facelift surgery can cause remaining filler to be puffier and more prominent than usual.

Patient safety and risk reduction is paramount in plastic and cosmetic surgery. Having any prosthesis or foreign body in our tissue can also increase the risk of postoperative infection, even if it was placed prior to the surgery itself.

Everyone’s face has some degree of asymmetry, and while facelift surgery does not create perfectly symmetrical faces, fillers can dissolve at different rates, creating uneven distribution of volume in the face. Hence when a facelift is performed with a significant volume of filler still present, it may result in facial asymmetry.

And finally, if the surgery displaces or reposition tissues that contain filler, the filler may look more prominent or out of place. If this occurs, we wait until facial swelling has dissipated (this can take a few weeks for some patients, or a many months for others) and then determine whether or not some of the filler may need to be dissolved to reduce its prominence, in its new position.

If you don’t dissolve your filler when recommended, some of these thing may happen – or none of them may happen! Such is the unpredictability of each individual’s surgical recovery, which is also dependent upon their overall health, nutrition, adherence to post operative instructions and state of mind, among other factors. Ultimately having surgery involves receiving advice and determining whether or not you will adhere to it in order to reduce risks and achieve a satisfactory result.

Should I avoid having filler right now, if I might consider a facelift one day?

If you are considering a facelift in the near future, we do not recommend having filler prior. Book a facelift consultation with an experienced specialist plastic surgeon and discuss your concerns and surgical objectives. They will develop a holistic plan for your face, which may include surgery, non surgical therapies or a combination of both. A good plastic surgeon will also tell you when it is too early to have a facelift, or when the risks may outweigh the benefits in your specific case.

If you are considering a facelift down the track (as in, years into the future) we do not insist that patients hold off on having dermal filler treatments now. The vast majority of people who have filler will never have a facelift – primarily due to the risks, very high cost and significant recovery. Abstaining from fillers now ‘just in case’ you have a facelift down the track is not necessary.

What if I have a permanent filler?

Permanent fillers raise other challenges when it comes to facelift surgery, as they have often been placed in other countries (such fillers are not commonly used in Australia). Most of the time our patients don’t know what type of product has been placed, which makes dissolving difficult as the choice of dissolving agent is determined by the type of filler. Sometimes, permanent fillers can only be removed intraoperatively, during the facelift procedure, when the product itself can be visualised and excised in situ.

Can fillers provide a facelift-like effect?

No injectable medicine can produce facelift like results, as facelift surgery is a major operation that lifts and tightens the underlying facial structure and excises loose skin in a way that lasers, skin products or injected medicines cannot. However, fillers can be an effective way of replacing volume and increasing facial projection, as well as mimicking bone structure. Likewise, facelift surgery does not replace fillers, as the surgery itself does not add volume.

If I’ve had dermal fillers in the past, can I have fat grafting at the same time as my facelift surgery?

Yes, in most cases. As mentioned above, facelift surgery does not replace the function of fillers in aesthetic treatments for the face as facelift surgery alone repositions volume around the face but does not create it. The exception to this is when facial fat grafting is performed at the same time as the facelift. Dr Sharp frequently combines facelift surgery and fat grafting, to add facial volume while improving overall skin quality. Fat grafts demonstrated to have not only dermal filler properties but also regenerative potential owing to the presence of stem cells in fat tissue.

Aesthetic medicine is not an exact science; both placing and dissolving filler involves risks and benefits, and should only be undertaken after these have been transparently provided by your clinic and carefully considered. Facelift surgery also carries significant benefits and risks, and being a major operation. These form an important aspect of the informed consent process, prior to undergoing plastic or cosmetic surgery.

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About Dr. David Sharp:

Dr. David Sharp is an experienced specialist plastic surgeon in Brisbane, with a special interest in breast, body and facial cosmetic surgery.

With over two decades of experience in medicine, Dr. Sharp has performed over 20,000 surgical procedures in Australia and has an established surgical and non surgical practice in Brisbane.

For more information and to schedule an appointment with Dr. David Sharp, please contact our patient support team at 3202 4744 or visit our online booking request form here.

This information is intended for general knowledge and should not replace personalised advice from your surgeon. Always consult with your surgeon for individual care.