Steps That Might Affect Future Facelift Procedures

Have you noticed how much younger everyone seems these days? A meme that’s been circulating on the internet for a while contrasts images of Golden Girls actress Rue McClanahan and Jennifer Lopez, both around age 50 or so, to drive the point home. A significant part of this is due to the advancement of plastic surgery techniques: Earlier forms of facelifts concentrated on tightening and pulling back surface-level tissues, which resulted in that notorious windswept look. Nowadays, surgeons go much deeper, to tighten lower tissues—and even the muscles—lifting them back and up and leaving a more natural-looking outcome. The addition of facial fat grafting and sculpting further improves results and can subtract a considerable number of years from one’s appearance.

But frequently, the actual reason people seem more youthful is that they’re putting in the effort well before going under a surgeon’s knife; the focus on prejuvenation has only intensified this phenomenon. We’re turning to consistent use of sunscreen, becoming dedicated to professional-grade skin care, and trying out new procedures that claim to offer results comparable—or at least similar to—those of facelifts. It’s truly remarkable to have all of these choices today, but if you eventually want a genuine facelift in the future, some of these shortcuts could potentially hold you back.

It’s crucial to remember that every patient is distinct. While the procedures below can adversely affect some individuals, they might not cause issues for others. To obtain the optimal outcomes now—and to enhance your prospects of having a successful facelift later—you’ll need to see experienced, board-certified providers and be truthful with them about your entire treatment history.

Injectable fillers

If you’re using hyaluronic acid–based filler moderately, all of our experts concur that you won’t have an excessive amount to worry about, though it’s worth noting that the filler you received years ago may still be present in your face. “This occurs frequently with the eyes,” remarks Dr. Jennifer Levine, a board-certified facial plastic surgeon in New York City. “People will have under-eye filler that you can still notice, even if they haven’t gotten it for 10 years.”

In such cases, you’ll need to be treated with hyaluronidase, sometimes multiple times, to dissolve what remains.

It’s when you’ve been using an excessive amount (or biostimulatory fillers, which we’ll discuss shortly) that you may encounter some problems. “If a patient truly desires to look like they did when they were in their 30s but has spent the past 15 years piling filler in their face and has permanently changed the original shape of the face, there is no way to return to a 30-year-old face,” cautions Dr. Amir Karam, a board-certified facial plastic surgeon in San Diego.

Years of using filler to create that pillowy look stretch the facial tissues in multiple directions, causing a reliance on volume that your provider may not be able to correct through fat grafting. “You’re never going to obtain a favorable result,” states Dr. Ben Talei, a board-certified facial plastic surgeon in Beverly Hills, California. “Not because you can’t go in there and lift the face, but because you have limitations in how much you can lift the face—even if you lift it to the maximum, they’re going to have deflation problems afterward.”

In other words, overfilling the face stretches the tissue to the extent that it will never regain its original elasticity; tissue that once behaved like a spring, stretchy balloon is now more like a ziplock bag. Those tissues will also not be able to recover as effectively after being treated with hyaluronidase. “They simply don’t have the ability to restore their natural hyaluronic acid like healthy tissue, where you’ll dissolve and then it’s producing hyaluronic acid again a few hours later,” Dr. Talei adds.

The fillers that are more prone to cause problems when going in for a future facelift are biostimulatory formulas like Radiesse, Sculptra, and Bellafill, which cannot be dissolved. While they sound appealing in theory, as they’re marketed as products designed to generate new collagen, there is a risk that they’ll create scar tissue in the process, which is more challenging to cut through and reposition.

Fat removal and skin tightening treatments

There are numerous procedures that fall into this category, ranging from noninvasive and minimally invasive to surgical options. Generally speaking, you don’t wish to remove fat from your face. “You have to comprehend how people’s faces age,” says Dr. Levine. “It’s very hard to restore that youthful softness to the face once you’ve made it more angular, which simply makes you look older.”

One such example is Kybella, an injectable commonly utilized to remove a double chin. When used improperly, it can create contour irregularities that may not be surgically correctable, says Dr. Karam. These are typically caused because the medication was injected too deeply under the platysma, which runs along the lower jaw, across the neck, and all the way down to the upper chest. “There’s truly not much fat laterally there,” says Dr. Talei. “There’s only fat centrally in the neck, and so you end up with these indentations in the middle of the neck, under the chin.”

To address unwanted fat as well as tighten facial skin laxity, deep radiofrequency microneedling and wand devices (such as FaceTite, AccuTite, and Renuvion) have become extremely popular. If you’re using these treatments to remove small amounts of supraplatysmal fat, says Dr. Talei, you’re completely fine. But if you’re using these devices on the face, you want to proceed with caution. “Attempts to use deep radiofrequency microneedling to tighten up deep muscle or fascia come at the expense of potentially melting and damaging that subcutaneous fat layer, because the fat is directly under the skin,” warns Dr. Karam, who spends a considerable amount of time educating the public on this matter through his social media platforms. “These energy devices direct energy through the skin, through the fat, on their way toward the deeper fascia and, along the way, damage that subcutaneous fat.” If you’ve seen the complaints on TikTok about RF microneedling making patients’ faces look older, this is the reason—fat keeps the face looking youthful. These pose an even greater threat to the integrity of your facial fat when performed poorly or aggressively.

Threads

Whether a history with threads will be an issue depends entirely on the skill of the provider and the materials they employed. The most common threads used nowadays are made of polydiaxanone (also known as PDO). It’s the same material used for sutures. If placed accurately, with proper facial structure in mind, PDO won’t create many problems, but it’s also unlikely to have a significant impact on you. “The results are extremely short-lived and have all the inherent complications associated with any invasive or minimally invasive procedure, like infection, irregularities, and pain deformity,” Dr. Karam says. Adds Dr. Talei, “The only area that it seems to have had any positive effect beyond what a filler can do is perhaps in the lateral midface.”

Threads can also cause some scarring beneath the skin’s surface. “When you insert absorbable suture material into the face, your body attempts to consume it back,” says Dr. Talei. “In the process, it ends up depositing some granules of scar tissue.” Dr. Karam notes that PDO threads tend to leave only streaks of scar tissue behind. When well placed, these threads may not even be visible: “I just performed a facelift on someone that I had personally inserted threads in, and I couldn’t see where I’d placed them in her face,” says Dr. Levine. However, permanent threads can present challenges for surgeons; they can create more scar tissue and must be removed during surgery.

Acne

OK, so this is, admittedly, not a procedure, but it’s still a common problem that can affect a surgeon’s ability to perform a facelift. A few blemishes over the years won’t cause a problem, but decades of severe acne and acne scarring can. “When operating on some patients with acne and a lot of acne scarring, you go in and find really distorted tissue planes [and the patient] bleeds a lot,” says Dr. Talei. “Ultimately, this won’t stop the best surgeons.”

Prior facelifts

After having one facelift, you might think that getting a second more than a decade later (and we’re not talking about revisions) would be relatively straightforward. Not so. “We tend to operate in something called the avascular plane, which doesn’t have blood vessels in it, making dissection very easy,” says Dr. Levine. It’s easy to cut through this plane on a patient who’s never had prior surgeries or scar tissue from the aforementioned procedures—not unlike gliding a scissor through wrapping paper. But if there’s a lot of scar tissue beneath there, “it’s like cutting through concrete,” she says. This results in a much more challenging, time-consuming, and high-risk procedure. In many cases, your provider won’t know if they’ll encounter these issues until they’ve begun to operate, which is why it’s so important to see a skilled provider—ideally, one who performs multiple facelifts a day rather than a few a month. The former will be more at ease in these situations than those with less experience. “If you’re accustomed to working in these fields, you just take your time and get through the dissection more slowly, more carefully, to avoid any structural damage to important anatomy like nerves and blood vessels,” says Dr. Karam.

Another way that a previous facelift can make a subsequent facelift more difficult to perform is the vector used. “For instance, if a prior surgeon pulled the face sideways and you’re trying to pull the face vertically, the horizontal vector in front of the ear often presents a challenge,” says Dr. Karam. This means it may be very difficult to close the skin back up after surgery, as too much could have been removed previously. “Sometimes you run out of skin in a direction that you feel is a more natural vector for rejuvenation,” he explains. “If the appearance is too extreme as a result of the previous surgery, we will have to forgo the opportunity to perform the surgery for the patient.”

None of this is to suggest though that providers expect you’ll avoid any and all aesthetic procedures in order to make a future facelift simple. “It’s naive, as a surgeon, to assume that by the time someone is going to need a facelift, they won’t have done any noninvasive procedures,” says Dr. Levine. “Yes, in an ideal world, having something that’s never been touched before is much easier to operate on… but people desire noninvasive treatments. Science and innovation are going to continue to progress, and it’s up to us, as doctors, to intelligently assess treatments to determine if they’re safe and effective for our patients.”