There is no single right answer when it comes to facial rejuvenation. Some patients are noticing accelerated volume loss after weight loss medications and want to know which treatment would best restore the shape of their face. Others have already received fillers for years and are wondering whether surgery would give them a longer return now that their face has aged more.
One question that comes up a lot at our consultations at Ridenour Plastic Surgery is, “Should I keep up with fillers, or is it time for a facelift?” The answer is never a simple one, and it takes a board-certified facial plastic surgeon with years of experience to help you analyze all of your options and make a good decision. Dr. Brock Ridenour has spent more than 30 years assisting patients in St. Louis with this and many other considerations.
Why Ask the Question of Facelift vs. Fillers?
Fillers and facelifts both improve the way your face looks, but they do it in fundamentally different ways and on very different timelines. It is a good idea to spend time with your surgeon to understand how each option works and how long the results can be expected to hold up in your situation. The right choice depends much less on which option is “better” in an objective sense and more on where you are in the aging process and what you want your results to look like five or 10 years from now.
How Dermal Fillers Work to Rejuvenate Your Appearance
Dermal fillers are injectable gels that add volume beneath the skin and are often made from a substance called hyaluronic acid (HA). Many of our patients recognize HA as an ingredient in their favorite moisturizing serum or other skincare products. This substance, which the body can also produce naturally to lubricate skin and joints, provides immediate volume and lift while helping to keep the skin hydrated. It can be injected into the face in the cheeks, lips, jawline, undereyes, wrinkles and other areas.
In 2024, HA fillers alone accounted for more than 5.3 million treatments in the United States, according to the American Society of Plastic Surgeons. Their popularity is due to effectiveness and convenience. Treatments take under an hour, require no downtime and produce visible results the same day.
Dr. Ridenour has served on advisory boards and speaker panels for several major filler manufacturers, including the JUVÉDERM National Speakers Group and the Merz Pharmaceutical Education Faculty. He has extensive experience across multiple product brands, offers virtually every dermal filler approved in the US, and specializes in matching the right products to each patient. He recommends based on what he believes will benefit the patient rather than being loyal to a specific product. These treatments and other aesthetic options are offered through the nonsurgical side of his practice, Aesthetica by Ridenour.
How Long Do Dermal Fillers Last?
Every filler is different, and longevity depends on the product as well as how quickly your body metabolizes it. How you take care of your skin can also play a role. Here is the average longevity for several of the most common dermal filler products we use:
- JUVÉDERM®: This family of fillers includes formulas like VOLUMA® XC, VOLBELLA® XC, VOLUX® XC, ULTRA and ULTRA PLUS. Each of these products has a different expected longevity, ranging from six months for lighter lip fillers to 24 months for thicker, deeper formulations.
- Restylane®: Restylane is another family of HA fillers with specific formulations for different facial zones, from lips to cheeks to under-eye hollows. Depending on the product and area treated, results typically last six to 18 months.
- Radiesse®: This filler is made from calcium hydroxylapatite and adds immediate volume while stimulating collagen production. Results typically last 12 to 18 months, with some patients seeing benefits for up to two years.
- Bellafill®: This is the longest-lasting FDA-approved injectable filler, made with PMMA microspheres that create a scaffold for new collagen growth. It’s FDA approved to last up to five years for smile lines, with clinical studies showing 83% patient satisfaction at the five-year mark.
What Are the Ideal Ages for Dermal Fillers?
There is no simple answer for the right age to start dermal fillers. Patients in their 20s and 30s are often most interested in treatments like lip enhancement or chin augmentation with fillers. Those in their 30s, 40s and 50s may want to address signs of aging like volume loss or wrinkles. Dr. Ridenour can help find the right treatments or procedures to keep your appearance fresh and youthful.
How a Facelift Can Help
During a facelift, Dr. Ridenour is able to lift and tighten the skin and the underlying layers, including the SMAS layer and underlying fat. These deeper layers are often responsible for some of the facial changes that happen with age, such as deepening folds and jowling along the jawline. This option is better for patients who have concerns beyond mild loss of volume. It is also preferable for those who want long-lasting results.
A study published in Plastic and Reconstructive Surgery measured facelift longevity using standardized photographs and found that 5.5 years after surgery, jowl correction showed only a 21% relapse in vertical height. In the same study, 76% of patients still looked younger than they did before surgery after this amount of time.
Facelift Results and How Long They Last
The First Year
Most swelling resolves within the first two to three weeks, but it can take up to a year for all of the swelling to completely go away. The tissues continue to settle throughout this period. Because of this, results may start to look their best at around the six-month mark and beyond.
Years Two Through Five
A well-performed facelift holds its shape throughout these years, especially if the underlying structures were corrected along with the skin. During this time, it can be helpful to have complementary treatments to help reduce the effects of continued aging in the tissues, such as laser or radiofrequency treatments to build collagen and tighten skin laxity. Other treatments, like Botox for expression lines, can treat areas that were not addressed with the facelift to provide overall balance.
The 10-Year Mark and Beyond
A standard facelift may provide visible improvement for 10 years or longer, though the face continues to age after surgery. Your results will not look the same at year 10 as they did at year five. Some patients choose a secondary lift after a decade, while others maintain their results with nonsurgical treatments alone.
Factors That Can Help Determine What’s Right for You
- Your Age and Where You Are in the Aging Process: Fillers may be the right fit in your 30s and 40s when early volume loss is the primary concern. A facelift addresses the structural changes, like sagging and jowling, that become more prominent in the 50s and beyond.
- The Specific Concern You Want to Address: Fillers restore volume and smooth lines. A facelift corrects sagging skin, jowls and neck laxity that no injectable can address.
- Your Timeline and Tolerance for Downtime: Fillers offer same-day results with virtually no recovery. A facelift requires 10 to 14 days of initial healing but delivers years of improvement from a single surgery.
- How You Think About Long-Term Investment: Fillers are a recurring cost every six to 18 months. A facelift is a one-time investment that typically lasts 10 to 15 years.
- Whether You Want to Maintain or Reset: If your current results still make you happy, fillers and injectables may be enough. If maintenance feels like it is no longer keeping up, a facelift may be the right option.
Why Many Patients Choose Both, and Why Timing Matters
Surgery and injectables are not always competing options; they are often complementary parts of the same plan. Fillers handle volume while a facelift addresses structure. Laser treatments and technologies like Ellacor micro-coring and EMFACE can be used to improve skin quality and tone. When sequenced correctly, combined treatments can provide natural-looking results that last longer than individual treatments.
What to Look for in a Provider for Either Treatment
Whether you are getting a small amount of filler or a full facelift, the person performing the treatment matters just as much as the product and technique. Board certification in facial plastic surgery is important because it means your provider has training specifically in managing aging in the face and neck areas and they understand the underlying anatomy.
Dr. Ridenour is double board-certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology. He is a Fellow of the American College of Surgeons and has served as a physician training site for filler and laser treatments. You can read more about our philosophy and hear from patients directly on our testimonials page.
Schedule a Consultation at Ridenour Plastic Surgery in St. Louis
The best way to decide between fillers, a facelift or a combination of both is a one-on-one conversation about your specific anatomy and goals. Call 314-878-8600 to schedule a consultation with Dr. Ridenour at our St. Louis office, or request a virtual consultation if you prefer to start from home. You can also browse real before and after facelift patient results in our face and neck lift gallery.
