Does early filler and Botox use complicate future facial plastic surgery procedures?

In the quest for that youthful glow, more plastic surgery patients than ever are starting their search for the fountain of youth at an earlier age. "Sephora kids" aren't hanging out at the mall; they are in beauty stores purchasing high-end, active-ingredient skincare products. Twenty-somethings are investing in Botox and fillers before crow's feet, fine lines and other signs of age start to creep across their features.

These noninvasive procedures may stall the march of time, but they can't stave off the effects of aging forever. As we age, a lack of elasticity, sagging skin and fat loss can make our face look older. Surgical procedures like a facelift are often the only treatments that can address these issues and make a significant difference.

But do years of consistent filler and neuromodulator use preclude or limit future procedures? If you invest in specific minimally invasive procedures today, are you risking your safety and results tomorrow if you want something more invasive?

Botox vs filler

First things first, Botox and fillers address ageing in different ways. Products like Botox are neuromodulators. Neuromodulators help soften the look of lines and wrinkles by temporarily paralyzing specific facial muscles. Depending on the patient, the effects can last three to six months but wear off over time.

Fillers, like hyaluronic acid fillers, treat the signs of aging differently. Hyaluronic acid is a naturally occurring substance in the skin. It helps provide hydration and volume, and when injected, smooths wrinkles and lines, while plumping the look of skin. The results are typically longer-lasting, anywhere from six to 12 months.

Do injectables complicate future facial procedures?

There isn't a simple yes or no answer.

"There is a lot of commentary on it without really any evidence," said Sara Dickie, MD. "Everything I've heard and witnessed is anecdotal."

Roy Kim, MD, said patients regularly getting Botox injections aren't an issue.

"I think that 'normal' patients should have no problems getting a facelift in the future," said Dr. Kim. "Botox given every three to four months, in reasonable quantities, should not really affect the facial tissues we care about as plastic surgeons. The problem is not really Botox or neuromodulators."

Currently, much of the information about potential complications may not be well studied or understood. As Dr. Dickie explained, it comes from anecdotal evidence from practicing plastic surgeons.

"I do facelifts and have never had a problem finding the right plane and having a good outcome in someone who has used fillers," said Dr. Dickie.

That's not to say it couldn't happen in other cases.

"I've heard other surgeons report on social media and once or twice at conferences that they have run into issues with 'fibrosis' or 'scar-like' tissue in patients who have used Sculptra or other 'biostimulatory' fillers," said Dr. Dickie. "I have not experienced this, and there is no evidence and no controlled study that has compared operative times, blood loss, wound healing complications or anything like that in patients who have had fillers versus those who haven't."

Yet, some surgeons have seen how these fillers can create complications.

"The problem is with facial fillers, a specific person may not be able to fully absorb them or break them down, and then you can see the filler on the SMAS, which is the tissue we want to reposition during a facelift," said Dr. Kim. "This can also be an issue with fat grafting during your facelift. Typically, we like to use your fat and not facial filler as the volumizing agent during your facelift. If you have filler there, I would not give as much fat, but as the filler goes away over time, you lack volume and may need a separate procedure down the road to 'fill up' the depleted area in your face."

Is that a significant complication? Maybe not, but it is a potential concern to keep in mind.

"As for HA fillers, again, I've seen videos on social media of filler gel being found during a facelift," said Dr. Dickie.

However, she explains that whether it is burdensome to undergo surgery or can cause significant complications, there isn't enough information available to tell. It may be portrayed as "terrible," but then again, plastic surgeons who encounter the issue and comment about it on social media are also not inclined to post bad postoperative pictures or give in-depth commentary.

What to consider if you regularly invest in filler

If you love filler, should you abandon any hope of undergoing surgical procedures in the future? Again, the answer depends.

"I do not think residual filler stops you from getting a facelift," said Dr. Kim. "The facelift surgeon just needs to be aware of the fact and be able to deal with it during your facelift procedure."

That means a candid conversation with your plastic surgeon about all your previous work, including noninvasive procedures like HA and non-HA fillers. Many patients do not view injectables as "plastic surgery procedures" because they are relatively quick and noninvasive. If you want more extensive surgeries, your plastic surgeon needs all the information about your medical history, including your use of injectables, to assess your health and risk factors and look for potential complications.

"I would say that anyone who wants filler and is worried about their future facelift should go get filler from a facelift surgeon and ask them about their experience," said Dr. Dickie. "But also feel safe knowing that fillers are safe. They are one of the most commonly performed cosmetic procedures around the world. There is no real evidence that they in any way impact the outcomes of facelift surgeries at this point."

The lack of scientific studies and mostly anecdotal accounts of issues and complications makes the conversation around this topic incredibly nuanced. The best way to determine if you are a candidate for a facelift or other procedure following years of injectable fillers is to consult with a board-certified plastic surgeon.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.