Face Fillers vs. Plastic Surgery

I want a more youthful complexion—what cosmetic procedure is right for me?
By Emily Hebert

Contrary to what you might assume, face fillers —Botox, Radiesse, Juvéderm, etc.—cost about the same as a face-lift: “The pricing doesn’t come out to be that different,” says dermatologist Doris

Face Fillers vs. Plastic Surgery

Contrary to what you might assume, face fillers—Botox, Radiesse, Juvéderm, etc.—cost about the same as a face-lift: “The pricing doesn’t come out to be that different,” says dermatologist Doris Day, MD, author of Forget the Facelift: Turn Back the Clock with a Revolutionary Program for Ageless Skin. “With face fillers, you pay less at a time, but since the results aren’t lasting, your procedures will add up to about the same cost of a face-lift in the long run.”

Yet despite comparable costs, the American Society for Aesthetic Plastic Surgery reports that while plastic surgery rates are dropping, nonsurgical treatments are greatly increasing. What gives? Day points to improved technology such as the new MiXto laser treatment and the growing range of face fillers on the market. Dysport, a Botox competitor, just got FDA approval—and Sculptra, an injectible that lasts for up to two years instead of the usual six to nine months, isn’t far behind. “There’s really something for everyone—now we have fillers that go deeper, that aren’t as superficial, and that come in a variety of consistencies and strengths,” she says, adding, “Sometimes I’ll inject more than one product in the same person—I’ll use an off-brand form of Sculptra to create some volume, and then I’ll use Radiesse, Juvéderm, Restylane, or Evolence to fill in what I need to fill in afterward. There are ways to mix them together to get the best results.”

Though injectable fillers have made huge strides in the past several years, there are some situations where plastic surgery is the best option. “Face fillers can treat certain lines and wrinkles. But their results expire and they can’t tighten the skin or reposition the deep tissues,” says plastic surgeon William Boss, MD. “And in cases where, for example, someone has a tremendous amount of excess skin in the neck area, they’re going to need a full face-lift procedure.”

For her part, Day agrees: “If your neck is really sagging, there’s nothing else to be done—it needs to be lifted and to have some skin removed. Also, if your upper eyelids are drooping over and you can’t see, you’ll need an eye lift. Those are the two main things I send people to plastic surgeons for—the neck and eyes.”

Age can also determine what route you take. “We take it on a case-by-case basis, but for people in their thirties or early forties, I generally look for noninvasive alternatives such as injectables,” says Boss. And even as you age and become a potential face-lift candidate, you don’t necessarily have to go all the way. Boss, whose practice is based in New Jersey, has developed what he calls the Cool Lift—a procedure that he’s been performing for just over two years and which mixes an internal laser treatment with suspension sutures. “Having seen how successful the laser was in shrinking the skin along the inner thighs, stomach, and arms, I incorporated it into a face-lift,” says Boss. “The laser is utilized to melt fat, tighten the skin, and recontour. Then suspension sutures are placed into the deep tissues to lift, and skin is removed.” According to Boss, his procedure differs from a full-fledged face-lift in that “minimal skin is elevated, it’s done under local anesthesia, and it has a shorter recuperation period—most patients can go out to dinner or back to work within five to seven days afterward.”

Even though technology and doctors are making it progressively easier to get a quick fix (note NYC’s SmoothMed, a walk-in Botox store owned by plastic surgeons), Day says that preventative steps and topical treatments come first. She recommends investing in a good SPF 15 or higher sunscreen or makeup, and looking for eye and face creams that contain retinols: “Anybody who can tolerate retinoic acid should use it,” she says. “Niacinamide is also a good ingredient—it’s an anti-inflammatory and antioxidant.” Day’s favorites? For face cream she likes Aveeno Positively Radiant Anti-Wrinkle Cream, Neutrogena Healthy Skin Anti-Wrinkle Cream, and Olay Regenerist Daily Regenerating Serum; for eye cream, she recommends Olay Professional Pro-X Eye Restoration Complex or SkinMedica TNS Illuminating Eye Cream.

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