What To Know About How Facial Fillers Impact Cosmetic Surgery

Forbes

2 days ago

If you're considering a facelift, whether now or in the future, you may want to keep reading this.
Non-invasive medical procedures, such as neuromodulators like Botox, hyaluronic acid fillers like Juvederm and biostimulators like Sculptra, have proliferated over the last decade and culturally supplanted face lifts as the primary method to achieve a youthful appearance. Recently, however, face lifts have made a comeback thanks to growing awareness of procedures like blepharoplasty, wherein a surgeon cuts into the creases of the eyelids, or deep-plane face lifts, which involve lifting and repositioning underlying tissues, including muscle and fat, and not just skin. In fact, there's a growing cohort of younger patients receiving facelifts. A recent report from the American Academy of Facial Plastic and Reconstructive Surgery found that roughly one-third of facelift patients are between 35 and 55.
Simultaneously, there is a growing body of evidence that fillers believed to be temporary do last longer in the body than previously understood. That has led to a larger conversation about how the treatments you receive today could impact a facelift procedure even a decade or more from now.
'It's very rare that I have a patient who's not done more than Botox or a chemical peel. I am more surprised when I treat a patient who's not had anything done,' said Dr. Lesley Rabach, board-certified facial plastic surgeon and co-owner of LM Medical.
While sources all agree that hyaluronic acid fillers are virtually a non-issue for facelifts because of where they are injected, some expressed concerns over products like Sculptra and Radiesse, PDO thread lift, and heat-based skin tightening treatments. The reason for this is that all of these treatments lead to a form of scar tissue because they trigger the body's inflammatory response to generate more collagen and heal the skin from its intentional micro-wounds.
There are 28 various types of collagen, but by far, the most common are types I through IV, with type I making up the majority found in the skin, providing its elasticity and firmness. Research shows that scar tissue is comprised mainly of collagen types I and III, but the fiber composition of the protein is different, hence the difference in texture and appearance from typical skin. If someone knows they want a facelift in the future, it's best to avoid procedures that create scarring, said Dr. Jimmy Sung, board-certified plastic surgeon and owner of Tribeca Aesthetics.
Sculptra and Radiesse in particular have benefited from marketing themselves as 'biostimulators,' referring to their ability to trigger the body to produce more collagen and replace lost volume. Sculptra is made of poly-L-lactic acid and directly provokes the body's inflammatory response. Meanwhile, Radiesse is made of calcium hydroxylapatite spheres suspended in a gel formula, which, when injected, also triggers a similar inflammatory response.
Introduced in the U.S. in 2004 and 2006, respectively, both products have benefited from the market decline in HA fillers and patients experiencing facial sallowness following GLP-1 use (and often referred to as 'Ozempic face'). Sculptra's first indication was for the restoration and correction of the signs of facial fat loss in people with human immunodeficiency virus (HIV). In 2009, Sculptra rebranded to Sculptra Aesthetic and received an approved FDA cosmetic indication for the correction of facial wrinkles due to aging.
'It's not good marketing to say this causes inflammation or scarring, so instead they say 'biostimulating.'... If there's a possibility [you'll get a facelift], then it's best to avoid it,' said Dr. Sung. 'But if you know you'll never have one, then yes, perhaps [you can receive it]. But I definitely don't think these products are suitable for young patients.'
One factor that's led to an issue for surgeons is the manner and location of biostimulators on the face. According to Dr. Bianca Molina, board-certified plastic surgeon and owner of Bianca Molina Plastic Surgery, Sculptra has been injected differently over the years in both depth and location, which influences its results. Because of this and the younger age of many facelift patients, the scar-like tissue is more visible to surgeons.
'The timeline on surgery has been moved way up to a younger age, so the effects of these injectables, [which are like] a scar reaction, or the actual product itself, is more present,' she said.
While she said she would not hold back on Sculptra for patients who are candidates now, provided they would not consider a facelift for at least a decade. However, she added that she would limit their treatments. Damage is always a risk for a facelift, regardless of cosmetic and health history, but when there are foreign substances in the face, it can heighten that risk. There can also be compromised aesthetic results, depending on the skill of the surgeon in dealing with such substances in the face, or if too much was injected. But that is a more severe outcome, she said.
But the one treatment she would never advise for patients who might have a facelift in the future is a PDO thread lift, which is polydioxanone dissolvable sutures that tighten sagging skin, particularly on the jaw and neck. She said she's generally 'not a fan' of the procedure regardless of a patient's interest in future facial surgery.
'I would never recommend it for anyone, ever, because it makes it very, very hard to do a good surgical procedure. I don't think those are ever worth it,' she said.
Dr. Rabach also agreed that a PDO thread lift is a more difficult situation to handle in surgery, and that non-invasive technologies that heat the skin, like Thermage, can also cause scar-like tissue, which poses a surgical challenge. In her opinion, Sculptra doesn't cause 'tremendous' scar tissue, but she does see it when she's performing a surgery. She advised waiting over a year for a surgical procedure if someone has received biostimulatory or skin-tightening treatments.
'I don't know so much if it impacts the results, unless it's somebody who's really been doing an excessive amount of all of it,' she said.