Non-surgical facial rejuvenation procedures have lasting effects on a tissue level. The "side effects" of some of these procedures can impact future facelift surgeries. Often, these effects are negative.
When planning and performing surgeries, it's crucial to consider previous non-surgical aesthetic procedures. If you're at a crossroads like this, make sure to fully inform your facelift surgeon about any previous medical aesthetic procedures you've undergone.
While I can't list every non-surgical procedure in this article, I can provide you with a general idea by highlighting commonly performed ones.
Fillers
Permanent fillers (such as silicone, PMMA, aquafilling, etc.) have adverse effects on all surgical procedures done on the face. Permanent fillers create adhesions and scar tissue within the tissues. The planes that separate the tissues are disrupted. Especially in SMAS subfacial techniques, we delicately separate the facial tissues from underlying nerves and muscles using microsurgical precision. Permanent fillers in the injected area make such surgical precision impossible. If a permanent filler becomes infected during surgery, it can lead to resistant infections causing tissue damage post-surgery. For this reason, I do not accept patients with permanent filler materials in their faces for surgery.
Filler materials triggering scar tissue formation within the tissue can also cause adhesions in deep tissue layers. When they talk about "smart" fillers promoting "new collagen formation," that new collagen is often another name for scar tissue within the tissue. Patients who have had "smart" fillers may not be candidates for deep-plane facelift techniques. I inform my patients that if I notice disruption in deep tissue planes during surgery, I might have to adjust the surgery to a more superficial level. If the patient understands that the final surgical plan might evolve during the operation, I proceed with surgery. "Smart" filler injections take away the freedom to choose techniques like deep-plane or HighSMAS facelifts.
Luckily, the mentioned fillers are rarely used. We often encounter Hyaluronic Acid-based fillers (Juvederm, Restylane, Teosyal, Belotero, etc.). These fillers do not complicate surgery and may even facilitate it. The only drawback of Hyaluronic Acid-based fillers is their potential to retain local swelling and cause prolonged puffiness after surgery. For instance, under-eye fillers can lead to extended puffiness around the injection site for 3-6 months post-surgery. Thus, sometimes it's necessary to dissolve these fillers before or after the surgery.
Technologies Applying Energy to Skin or Subdermal Layers:
Applications that apply energy to the skin, causing burns in the deeper layers, can negatively affect the skin's blood circulation. Procedures like ND:YAG laser or CO2 laser, over repeated sessions, can disrupt the skin's capillary circulation, leading to thinning and reduced skin elasticity. Patients with such history should avoid superficial surgical techniques due to increased risk of tissue loss. Technologies that apply energy to subdermal layers can damage the SMAS layer. Focused ultrasound, needle radiofrequency, and similar techniques can cause adhesions and hardening in superficial muscle and connective tissue layers. In patients who have had these repeated sessions, performing deep-plane facelifts or HighSMAS techniques can become technically challenging.
Some subdermal energy application technologies melt the very thin compact fat layer just beneath the skin. This layer is crucial for surface quality. In patients with superficial tissue loss, micro-fat grafting sessions before and after surgery might be necessary to restore this compact fat layer. This incurs additional sessions and costs.
Thread Lifts
Thread or mesh applications using absorbable threads have little impact on surgery. However, procedures with permanent threads adversely affect techniques like deep-plane facelifts or HighSMAS techniques. Permanent thread materials can pierce nerves or muscles and might not be removable. Transitioning from superficial to deep tissue planes becomes difficult. Implant materials like permanent silicone used in procedures like the French thread lift can mimic "nerves" within the tissue, complicating surgery dissection. Hence, surgeries become more complex in patients with such implants, leading to increased surgical costs.
Botox
Botox injections into the masseter muscle slim the face from the side and disrupt the transition between the cheek and neck. Unless there is a strong indication, we do not recommend this for aging patients. In this group, the contour of the jaw and neck might be suboptimal after facelift surgery.
Constant Botox injections into the frontal muscle in the forehead can weaken the muscle significantly, causing brow descent. Lowered brows, combined with tissues lifted during a facelift, can lead to overcrowding in the temple area. In such cases, combining brow lifting surgery with facelift surgery is beneficial.
Finally, when Botox infiltrates the temple region and causes muscle atrophy in the temporal chewing muscle, 2-3 sessions of fat grafting before or after surgery might be needed to correct the depression in the temple area.
When discussing potential outcomes of non-surgical procedures, it might seem as if I am against everything non-surgical. I am not against these procedures. I also administer fillers and Botox. However, transparency is key. These procedures have advantages and disadvantages. An experienced surgeon specializing in facial rejuvenation will assess your history with non-surgical procedures and determine the best treatment strategy for you. Sometimes, this strategy might not align perfectly with your desires or the "ideal treatment," but patient safety always takes priority. Remember to inform your surgeon comprehensively.
Stay well, stay beautiful.
Warm regards,
O.B.