The desire to maintain a vibrant, youthful appearance is universal. When gravity and time begin to leave their mark—deepening nasolabial folds, creating jowls, and hollowing the cheeks—you are faced with a fundamental decision: Do I choose a Facelift or Dermal Fillers?
This is one of the most common questions we address at our Plano practice. While both treatments aim to restore a smoother, more refreshed face, they treat different underlying issues and offer radically different levels of permanence, recovery, and scope.
Choosing the right path depends entirely on your age, the degree of skin laxity, and your tolerance for downtime.
Here, Board-Certified Plastic Surgeon Dr. Jeff Angobaldo, MD, breaks down the core differences, helping you understand whether you are better suited for the subtle maintenance of fillers or the comprehensive, long-lasting correction of a Facelift.
1. Dermal Fillers: The Volume and Maintenance Solution
Dermal Fillers are a non-surgical, injectable treatment primarily used to restore lost volume, smooth static wrinkles, and enhance facial contours. They are a staple of cosmetic maintenance and a fantastic tool for patients seeking subtle, temporary improvements.
The Ideal Fillers Candidate
Fillers are best suited for patients experiencing early signs of aging where volume loss is the primary concern, not severe skin laxity.
· Primary Issue: Volume Depletion. This
includes hollowing under the eyes (tear troughs), flattening of the cheeks, and
the appearance of prominent nasolabial folds (smile lines) due to fat or bone
volume loss.
· Skin Quality: The patient has good to
moderate skin elasticity and only minor jowling. Their facial structure is
still generally firm.
· Duration: Results are temporary,
typically lasting from 6 months to 2 years, depending on the type of filler
(Hyaluronic Acid, Calcium Hydroxylapatite, etc.) and the area treated. Fillers
require ongoing maintenance appointments.
How Dermal Fillers Work
Fillers work by physically adding structure or volume beneath the skin’s surface:
- Restoring Structural Support: In areas like the cheeks or temples, fillers mimic the structure of bone or fat that has been depleted with age.
- Plumping Fine Lines: They push up the skin from underneath, softening the appearance of creases and folds that are present even when the face is at rest (static wrinkles).
- Hydroscopic Action: Hyaluronic acid (HA) fillers, the most common type, attract and retain water, which helps the skin retain moisture, hydration, and volume over time.
2. Facelift (Rhytidectomy): The Comprehensive and Lasting Correction
A Facelift, or Rhytidectomy, is a surgical procedure designed to
correct the most visible signs of aging by addressing skin laxity, jowling, and
the descent of deeper facial tissues. It is the gold standard for long-term
facial rejuvenation.
The Ideal Facelift Candidate
A Facelift is necessary when non-surgical options can no longer effectively address the severity of aging.
- Primary Issue: Significant Skin Laxity and Jowling. The patient shows prominent sagging in the lower face and neck, with jowls obscuring the jawline and deep bands forming in the neck.
- Aesthetic Goal: Comprehensive restoration of the neck and jawline, removal of jowls, smoothing deep folds, and achieving a result that lasts a decade or more.
- Duration: Results are long-lasting, typically maintaining a rejuvenated appearance for 8 to 12 years, as the surgery physically repositions the underlying structural layers.
How a Facelift Works
The modern Facelift, particularly a Deep Plane or SMAS Facelift, is not just about tightening skin; it’s about surgically repositioning the underlying muscular layer.
- Targeting the SMAS: Plano works beneath the skin to lift and suspend the Superficial Musculoaponeurotic System (SMAS), which is the foundational layer responsible for facial droop.
- Redefining the Jawline: Jowling is corrected by lifting the SMAS layer back to its youthful position, restoring a sharp, distinct jawline contour.
Concealed Incisions: Incisions are meticulously hidden within the hairline, behind the tragus of the ear, and along the natural creases behind the ear
3. Understanding Facial Aging: The Three Core Components
A single procedure cannot fix all signs of aging. Successful facial rejuvenation requires addressing three distinct components simultaneously. A Facelift addresses the first component, but for a truly natural and complete result, volume and surface must also be corrected.
Component of Aging | The Problem | The Best Solution |
I. Laxity (Skin & Muscle) | Drooping jowls, heavy neck bands, and descended facial features. | Facelift (Rhytidectomy): Lifts and tightens the deep structural SMAS layer. |
II. Volume Loss | Hollowing in the cheeks, temples, and under the eyes. | Fillers or Fat Transfer: Adds dimension and shape back to the face. |
III. Surface Quality | Fine lines, sun damage, pigmentation, and overall skin texture issues. | Skin Treatments: Chemical Peels, SkinPen (microneedling), or Laser Resurfacing. |
Important Distinction: A Facelift addresses Component I (Laxity), but it does not address Component II (Volume Loss) or Component III (Surface Quality). This is why combination therapy is essential for the best outcome.
4. Core Differences: Action, Longevity, and Downtime
The choice between a Facelift and Fillers is determined by the severity of the sagging, the longevity desired, and the patient’s willingness to undergo surgery.
Feature | Dermal Fillers | Facelift (Rhytidectomy) |
Primary Action | Adds Volume (Plumps and Fills) | Removes Excess Skin and Lifts Deep Tissue |
Treats | Volume loss, static wrinkles, mild hollowing | Severe jowling, neck laxity, and descended facial features |
Longevity | Temporary (6 months to 2 years); requires constant maintenance | Long-Term (10 to 15 years); one-time comprehensive procedure |
Downtime | Minimal (0–2 days) | Significant (2–3 weeks of social recovery) |
Cost | Lower per session; higher cumulative cost over time | Higher upfront cost; lower long-term cost |
5. The Bridge: Combining Surgery and Non-Surgery for Total Rejuvenation
The best results in modern plastic surgery integrate the lift with volume and surface refinement:
Facelift with Fat Transfer: Correcting Laxity and Volume
Dr. Plano frequently combines the Facelift (to correct Laxity) with Fat Transfer or dermal Fillers (to correct Volume Loss).
- Fat Transfer is often preferred with a Facelift as it provides a natural, long-lasting, and abundant source of volume to areas like the cheeks and temples, where aging has caused hollowing. This combination provides both the lift and the volume needed for a youthful contour.
The Final Polish: Laser and Peel for Surface Quality
To complete the transformation and address Skin Quality, patients
often undergo subsequent treatments like a Chemical Peel or a Laser
Resurfacing treatment to smooth fine lines and address sun-damaged spots
that no amount of surgical lifting or filling can fix.
By combining a Facelift (Lift) + Fat Transfer (Volume) + Laser/Peel
(Surface), Dr. Plano 0effectively targets all three components of facial aging
for the most natural and comprehensive result.
Conclusion: Let Your Anatomy Decide
The right choice isn’t about preference; it’s about what your anatomy
requires.
If you have minimal skin laxity, but your face looks tired due to volume
loss, Fillers are likely your solution. If your main concern is a heavy neck,
noticeable jowls, and severely drooping skin, only a surgical Facelift can
provide the comprehensive, long-lasting lift you need.
The only way to definitively determine your unique needs is through a
thorough, personalized consultation. Dr. Jeff Angobaldo, MD, will assess your
skin quality, examine the underlying SMAS layer, and discuss your lifestyle to
recommend a custom plan, ensuring your result is both natural and enduring.
Ready to find out if volume replacement or structural lifting is right for
you? Contact our Plano office today to schedule your confidential facial
rejuvenation consultation.
