Injectable filler is a potent and minimally invasive treatment capable of numerous effects. It can hide marionette lines near the mouth, smooth out bumps on the nose bridge, shape the jawline, and even enhance sagging earlobes – all with little to no recovery time and almost immediate outcomes, aside from some potential minor swelling and/or bruising. Despite the remarkable and extensive capabilities of filler, there are times when choosing plastic surgery makes more sense.
“Filler reaches its limit when you're no longer aiming to restore volume,” remarks Dr. Ari Hoschander, a board-certified plastic surgeon in Rockville Centre, New York. “Fillers are employed to restore volume to the skin and face in areas where it might have been lost. When you're attempting to correct structural issues, such as sagging skin and fine lines and wrinkles, these are not optimally treated by filler.”
Herein, we're spotlighting some situations where plastic surgery is likely the preferable choice compared to injectable filler. While surgery is more invasive and costly than a quick procedure like filler, the upside is that you're likely to obtain better and more enduring results.
1. Facial laxity
As we age, volume loss takes place in our face, potentially causing sagging or drooping in the cheeks, nasolabial folds, and around the jaw (“jowling”). While certain treatments – like Thermage, Ultherapy, Fractora, and Morpheus8 – can slightly enhance the appearance of mild facial laxity, filler doesn't offer significant help in this regard.
“To address facial sagging, injectors frequently insert filler in the cheeks, temples, nasolabial folds, prejowl sulcus, and posteriorly in the jawline. All these actions aim to lift the face,” notes Dr. Catherine Chang, a board-certified plastic surgeon in Beverly Hills, California.
However, she states, what often occurs is that you might notice some minor improvement in the lift aspect, but the face ends up looking full and wide due to the quantity of filler required. It's also a temporary solution.
“I discover that a surgical intervention involving a deep plane facelift and/or neck lift leads to a much more natural look and helps improve the jawline's appearance, lifts the cheeks, and softens the nasolabial folds,” Dr. Chang says. “A face and neck lift will assist in restoring the position of the soft tissue instead of concealing, as filler does. And those with considerable jowling will benefit more from a facelift, which directly tackles the sagging.”
2. A disproportionately large nose and/or breathing problems
Nonsurgical rhinoplasty has grown increasingly popular in recent times. There's no doubt that it can make a notable difference in facial symmetry and improve minor flaws.
“There are numerous patients who can benefit from adding filler to their nose, especially those with minor contour issues,” mentions Dr. Tanuj Nakra, a board-certified oculoplastic surgeon based in Austin, Texas.
However, filler does have constraints when it comes to rhinoplasty, and not everyone is a suitable candidate for that attractive “lunch-hour nose job.” To begin with, Dr. Nakra says that those with larger noses might find that a liquid nose job actually makes the nose even larger, which may not be desirable. Also, it's not ideal for those with significant asymmetries and structural problems.
“There are many patients seeking aesthetic nasal refinement who are not suitable candidates for a filler rhinoplasty,” says Dr. Nakra. “Situations not suitable for filler rhinoplasty include a disproportionately large nose, severe asymmetry, a bulbous – or large and boxy – nasal tip, and internal breathing problems. These patients truly need surgery to directly address the anatomical issues.”
3. A recessed chin
Filler is an outstanding tool for temporary jawline shaping, but it might not be the top choice for those seeking a more lasting, defined chin.
“If someone is eligible for a chin implant, I always suggest a chin implant over filler,” Dr. Chang says. “Filler is soft and, over time, can appear amorphous and saggy. [With a chin implant], you can anticipate an improvement in the overall balance of your facial profile and the contour of your jawline.”
A chin implant also provides a firmer, more distinct look, and it's a permanent solution compared to one you'll have to repeatedly treat each year. Moreover, Dr. Chang says that the procedure can actually contribute to more graceful aging, particularly in cases of a genetically weak or recessed chin.
4. Very thin lips
Dr. Nakra states that lip filler is highly beneficial when targeting an isolated volume problem – and the ideal candidate is someone with mild age-related volume loss or a mild case of thin lips. In either situation, a small amount of filler can have a significant impact and look very natural when administered by a skilled injector.
“If the lips are genetically very thin, then a surgical lip lift can be much more effective than fillers because the lip lift will ‘flip’ or rotate the lip outward, [causing the lips to] appear fuller more naturally,” explains Dr. Nakra.
He adds that another case where a surgical lip lift is often more effective is in age-related elongation of the upper lip. Dr. Nakra explains that as we age, the distance between our nose and mouth increases. Lip filler cannot resolve this issue. In fact, filler can potentially cause distortion and make the lip drop even further in this scenario.
Where filler falls short, a surgical lip lift reduces this space in a natural-looking manner. It also permanently alters the overall shape of your lips, increases the fullness of the upper lip, and shows more of your upper teeth when smiling, notes Dr. Hoschander.
5. Sunken under-eyes
We tend to focus on the area around our eyes as an indicator of aging. After all, this area often shows some of the initial signs like fine lines and wrinkles, eye bags, and hollowness. However, when it comes to hollow or sunken under-eyes, both Dr. Chang and Dr. Hoschander say that filler is seldom their first option.
“If it's a small amount, I think it's acceptable, but repeated or excessive filler placement in the lower eyes can lead to swelling of the lower-eye area. This can be difficult to correct,” Dr. Chang explained. “I typically recommend surgical correction instead, to genuinely address the anatomical issue rather than attempting to mask the area with filler.”
Dr. Hoschander concurs, adding that under-eye filler comes with certain non-negligible risks. This ranges from minor side effects such as tiny nodules or bumps to, more rarely, blindness if the filler is injected into a blood vessel.”
The preferred surgical treatment is a transconjunctival lower blepharoplasty. This outpatient procedure requires approximately a week of recovery time due to bruising and swelling, but promises remarkable and long-lasting results.
When in doubt, a consultation with a plastic surgeon can assist you in determining the best way forward to achieve your aesthetic goals.
