Facelift or dermal fillers? How to choose the right approach for facial rejuvenation

When you decide on facial rejuvenation, you very quickly come to the same dilemma: should you start with dermal fillers, or should you rather consider a surgical face lift, a facelift. On the surface, they seem to have similar goals, but in reality these are two quite different approaches. They address different problems and have very different duration of effect.

In this article, you will find a guide that helps you understand when fillers are more appropriate, when a facelift is more appropriate, and when the best option is a combination of both. The aim is that you come to your consultation informed and with realistic expectations.

What is the difference between a facelift and fillers?

A facelift is a surgical procedure in which the deeper facial structures are lifted and reshaped, together with the skin. A classic SMAS or deep-plane facelift does not tighten only the skin. It also repositions the musculoaponeurotic layer and the fat pads back into a more youthful position. The result is:

• a more clearly defined jawline
• youthful cheek contours without loss of volume
• a smoother transition between the face and the neck

The effect of a facelift lasts approximately 10 to 15 years, depending on the type of procedure, the patient’s age, and lifestyle.

Fillers (most commonly hyaluronic acid fillers) are non-surgical treatments used to replace lost volume, soften specific wrinkles, and subtly lift certain facial areas. They are most often used for:

• augmentation and shaping of the cheeks and lips
• softening of nasolabial folds
• lifting “downturned” oral commissures (mouth corners)
• filling smaller depressions and irregularities

The effect of fillers is temporary. Most hyaluronic acid fillers last about 6 to 18 months, then gradually degrade and maintenance treatments are required.

When should you consider fillers?

Fillers are an excellent option when signs of ageing are still moderate, when there is not much excess skin, and the main issue is volume loss and the appearance of early fine lines.

They are typically suitable for women who:

• notice early midface volume loss, but the skin is not yet significantly lax
• want fuller, better-shaped lips
• want fuller cheeks or a more defined facial contour
• have more pronounced lines around the nose and mouth, but the lower face is not yet “drooping”
• want a discreet change without surgery and with minimal downtime

Advantages of fillers:

• an outpatient procedure completed in a few minutes
• quick recovery, usually you can return to normal work the same day or the next day
• results are visible almost immediately, and finalise after a few days when swelling subsides
• the dose is tailored to your preferences for a natural look

Key considerations with fillers:

• they are temporary and maintenance treatments are needed
• they do not remove excess skin
• they cannot truly lift markedly descended tissues
• overcorrection can quickly lead to an “overfilled” or unnatural appearance

When is it time for a facelift?

A facelift becomes a reasonable option when the problem is no longer only reduced subcutaneous volume, but primarily:

• excess, sagging skin
• a softened, poorly defined jawline
• jowls or hanging folds in the lower face
• neck and submental laxity

This is most common in women after the age of 45 or 50, but it can also occur earlier, especially in occupations with high sun exposure or exposure to chemicals. Due to UV radiation and other factors, including genetic factors, the skin can lose elasticity faster, so people may appear older than they are.

Advantages of a facelift:

• a longer-lasting result, often 10 years or more
• it truly lifts and repositions deeper structures, not only replacing lost volume
• it can correct more pronounced laxity that fillers can no longer meaningfully improve
• it prevents an “overfilled” look that can occur with repeated filler treatments over time

Key considerations with a facelift:

• it is surgery and requires anaesthesia and recovery
• scars are present, but concealed along the hairline and around the ears
• rest and limitation of physical activity are needed for the first few weeks

Combining a facelift and fillers

In practice, a facelift and fillers often complement each other, rather than exclude each other.

Facelift:

• lifts and reshapes structures
• improves the contour of the face and neck

Fillers:

• restore cheek volume when needed
• soften finer lines that surgery cannot fully address
• help refine details after surgery, for example subtle balancing of the cheekbones

It is important not to overuse fillers before a facelift and over long periods of repeated treatments, as newer research suggests that fillers can persist in tissues longer than what is visible on the surface and can influence tissues and lymphatic flow.

Therefore, for patients planning a facelift, it is sensible to inform the surgeon during consultation whether fillers have been used previously, which types, and how much. Sometimes, to achieve a better final result, part of the filler must be dissolved before surgery.

5 key questions before deciding between a facelift and fillers

1. How pronounced is skin laxity?
   If your main concern is fine lines and mild volume loss, fillers are a logical first step. If the lower face and neck are visibly sagging, a facelift is a more realistic solution.
2. Are you prepared for surgery and recovery?
   If you currently do not have the time or ability for two to three weeks of a calmer pace, fillers (or other non-invasive treatments) are a more practical interim option.
3. What result do you want, and for how long?
   Fillers are excellent for testing subtle changes and achieving a short-term effect. If you want a one-time, more significant change that lasts many years, it is worth considering a facelift.
4. What is your age and skin condition?
   Between 35 and 45, a combination of fillers, skincare, and less invasive procedures is often sufficient. At 45+ with moderate to significant skin laxity, a facelift is often the main solution, with fillers as support if needed.
5. What is your relationship with “maintenance”?
   With fillers, you should plan for regular visits and costs every few months to years. With a facelift, the investment is higher upfront, but it effectively “resets the clock” on the face for a longer period.

Where to start if you are considering both options?

Če vas zanima predvsem dvig obraza in bi radi razumeli, kaj je pri vas realno, vas vabimo, da si preberete več o samem posegu:

Facelift - Klinika Višnjar in Ljubljana

At the consultation, we will openly discuss what bothers you, what you have already tried, and what result you want. We will then realistically assess whether fillers, a facelift, or a combination of both is most appropriate for you, and in what sequence.

The key point is not a “fashion trend”, but that you achieve a natural result that truly delights you when you look in the mirror.