The Liquid Face Lift

by Dr. Steven Wallach

A “buzz phrase” that I have been hearing for quite some time and certainly being marketed by both core aesthetic physicians ( Plastic surgeons, ENT, oculoplastic surgeons, and dermatologists) as well as non-core physicians( everyone else) is the “Liquid Face Lift.”  So what does this mean? Usually this refers to a non-surgical procedure injecting neuromodulators such as Botox and Dysport, and injecting fillers like Restylane, Perlane, Juvederm, Readiesse, or Sculptra.  The neuromodulators deactivate some muscles of the upper 1/3 of the face and perhaps elevate the lateral brow, hence the lift. The filler products fill out the areas of the cheeks, the nasolabial folds, the oral commissure and lower jaw line and even the brow to provide either camouflage  or true fill to enhance the facial anatomy, again giving a blended or lift appearance for some.  I think for many of my younger patients this is a great way to go, but in no way do I think this is the solutoin for everyone.  As we age, there are two things going on: 1) facial fat atrophy, and 2) loss of skin elasticity.   In my opinion, the “danger zone” is when patients are over-filled with product and look like marshmallow faces because the injector tries to fill them out so much to compensate for the poor skin elasticity.  In these cases, the patient needs a facelift in conjunction with moving soft tissues in the face, and/or combined with fat injection, and perhaps filler products.  As a plastic surgeon I can offer patients all these things, and I am keenly aware when patients need one, the other, or both.  In addition, a brow lift can do things that the neuromodulators can not do  as well, but it does not mean there is not a place for both.   I always say too much of one ( fillers, and Botox/Dysport) or the other( surgery) is not natural but often a combination of the two is best!