In the current landscape of aesthetic medicine, the line between the medspa and the operating room has blurred. Most patients don’t arrive for a surgical consultation with a "virgin" face; they arrive with a history of nonsurgical treatments and facelifts already on their radar. They’ve had the hyaluronic acid fillers, the annual radiofrequency treatments, and the preventative liquid facelift. "So, do nonsurgical treatments make my facelift more complicated? The answer is... complicated. Let's break down nonsurgical treatments into three different categories." To understand how a minimally invasive procedure affects a surgical facelift, we have to look at how these treatments interact with the facial anatomy long after the initial swelling has faded. More of a verbal learner? Watch Dr. Locketz's Instagram Reel that dives into this topic here.
The first category includes the heavy hitters of skin tightening and facial rejuvenation.
"We've got energy-based devices like radiofrequency microneedling, FaceTite, NeckTite, Ultherapy, Thermage: things that deliver heat to the deep structures of your face."
These ultrasound treatments and radiofrequency treatments work by delivering focused ultrasound energy or heat to the deep facial tissues. The goal is to stimulate collagen production by creating a controlled thermal injury. While this results in firmer skin for a period, it also creates something called sub-clinical fibrosis—microscopic scar tissue.
When a board-certified plastic surgeon or facial specialist performs a deep plane facelift, they must navigate the superficial muscular aponeurotic system (SMAS) with extreme precision. If the tissue has been "cooked" by repeated heat-based professional treatments, that tissue becomes woody, brittle, and less pliable.
"Then we have injectable fillers like hyaluronic acid."
The second category is the most common: soft tissue fillers like hyaluronic acid. These are used to restore volume in the nasolabial folds or to smooth wrinkles.
While a hyaluronic acid filler is temporary and dissolvable, its presence during a surgical procedure creates a moving target for the surgeon. During a surgical facelift, we are essentially redraping the foundation of the house. If that foundation is filled with a gel that mimics facial volume, the final drape may be inaccurate once the filler eventually dissipates.
"And then we have biostimulatory fillers like Sculptra and Radiesse."
The third category involves products designed to stimulate collagen over time, such as Sculptra or Radiesse.
Unlike a liquid facelift using HA, these fillers are designed to provoke a biological response to create collagen growth. This is excellent for improving skin texture and skin quality, but it creates a very specific challenge for a facelift surgeon. These fillers don't just sit in the tissue; they integrate into it, often creating dense planes of scar tissue where there should be natural gliding spaces.
"Now, all of these things can make the actual surgery more challenging, but that's not really a big deal. If you're a competent surgeon and you do a lot of facelifts, you can get through a facelift no problem, even if someone's had a lot of these treatments."
If you have spent years on ongoing treatments to avoid sagging skin, you might worry you’ve ruined your chances for a successful surgery.
A skilled surgeon understands that the surgical facelift is the gold standard for significant skin laxity. While nonsurgical options like laser skin resurfacing or chemical peels are fantastic for skin texture, they cannot address the structural failure of the facial muscles. A surgeon who specializes in the deep plane facelift is used to navigating complex anatomy. The difficulty of the surgery itself is the surgeon's burden to carry, not the patient's.
However, there is a "but."
"But the reality is that it can make your recovery and sometimes your result less predictable. Energy-based devices can affect the blood supply to your skin and what we call the subdermal plexus. So that means as your facelift is healing, the skin can heal in ways that we don't predict. Sometimes it can develop fibrosis and heal with a little bit of wrinkling, or sometimes it can be slow to heal."
While the surgery can be completed, the behavior of your face during healing changes after years of non-surgical facelift attempts.
When we perform facelift surgery, the skin relies on a delicate network of blood vessels (the subdermal plexus) to heal. Repeated laser treatments and skin-tightening heat can compromise this blood supply. This doesn’t mean you won't heal, it means the facelift recovery might involve more swelling, or the skin might not settle as smoothly as it would on a patient who had never had radiofrequency treatments.
"Hyaluronic acid fillers, if they're in your face during surgery, they can be moved around during surgery, or they can be dissipated completely. So, in an area where you're used to having filler after surgery, there won't be filler there anymore, and you can end up with depression in that area that we just can't predict."
Fillers present a different hurdle during the surgical procedure.
Many patients use fillers to mask facial volume loss for years before opting for cosmetic surgery. During surgery, the mechanical manipulation of the tissues often causes these fillers to break down or shift. If your treatment plan relied on filler to hide a hollow area, and that filler disappears during the lift, you may wake up with a depression or a lack of volume that we couldn't account for while the filler was masking the true facial structure. This is why I often prefer to dissolve fillers before a traditional facelift to see the true skin laxity and anatomy.
"Biostimulatory fillers are a little bit different. Sculptra and Radiesse can certainly create scar tissue in planes that are really necessary for us to be able to divide evenly during surgery. So when we run into those challenges, we can work around them. We can go a little more superficial or go a little more deep to get around those scarred areas. But that means you can end up with a little bit more bruising after surgery, or sometimes you can end up with a little bit of skin compromise. We have to go more superficially to get around those areas."
Biostimulators are perhaps the most physically disruptive during the actual dissection of the facial tissues.
To get the most natural, tension-free result, we need to move through the clean planes of the face. When biostimulatory fillers have created a tapestry of scar tissue, we have to adjust our depth. This deviation is what leads to increased bruising or minimal downtime becoming slightly more extended downtime.
"So, do nonsurgical treatments affect your facelift? Well, if you're a good surgeon, they don't affect the actual process of doing a facelift. You can still get through a facelift, but it can affect your recovery, and sometimes it can affect your result."
The key is comprehensive rejuvenation and realistic expectations. Nonsurgical treatments are excellent for mild skin laxity, acne scars, and improving skin texture. They have a lower upfront cost and offer minimal downtime. But they are not a permanent substitute for a surgical facelift.
If you are considering facelift surgery in the future, my advice is to be transparent about your history of cosmetic procedures. Whether it was ultrasound therapy, laser skin work, or multiple treatments of hyaluronic acid, your surgeon needs to know.
My goal is to make sure that when you're ready to transition from maintenance to mastery, your recovery and result are as predictable as possible. By being transparent about your history with energy-based devices and dermal fillers, we can navigate your previous treatments with precision to leave you happy with your results.
