In our practice, we’re often asked: “What do I need, Botox, filler, or surgery?” The short answer is you don’t need any of it. It’s more a matter of what distracts you when you look in the mirror and what you want to do about it. There are more choices on the market than ever before––to make you look more rested, younger, and even more attractive. But there isn’t one right answer or cure-all. So when it comes to the cosmetic injectables versus plastic surgery question, how do we give the right answer? 


Remember, it’s different for every patient 

First, it’s important to understand the overall effects of facial aging when we make our decisions. And to use our training and experience to offer suitable recommendations for each patient. Before training, you might not realize why the skin becomes looser as we age. It’s a combination of collagen and elastin loss, sure. But also loss of facial fat, muscle mass, and bony support. All of these factors cause a breakdown of the scaffolding that holds the skin up. 

Armed with this knowledge, you can educate your patients as well. We always teach our students the art of communication, as well as the art of injectables. The skin is an amazing organ that keeps us warm when it’s cold, cool when it’s hot, and keeps environmental toxins and germs out. For every patient, we always start with recommending a proper skincare routine––if these basic needs (i.e., cleansing and sunscreen) aren’t met, then no cosmetic injectables or plastic surgery will help! From there, we can address specific concerns and find the best course of action. 


Plastic surgery pros and cons 

While we’re on the subject of saggy skin, there are several non-invasive skin tightening modalities including lasers, ultrasound, and radiofrequency. And, for the right clients, these can be helpful. But for others, plastic surgery may be the more appropriate option. The facial plastic surgeon we often work with in Portland uses this analogy: “If I take a quarter-inch off the putting green, it can be significant. If I take a quarter-inch off the rough, who’s going to notice?” 

In other words, younger clients with thick, healthy skin may see a one to two-millimeter lift with a non-invasive treatment. When there is mild to moderate skin laxity, however, this can be significant. But, in this case, one to two milliliters may be indiscernible. Most over the age of 50 will have a less robust response to non-invasive treatments and may require plastic surgery to achieve their desired results. 

In some cases, it’s important to tell these patients that we can give minimal improvements in problem areas with bulk heating, neurotoxins, and fillers, but that surgery may be the only definitive answer. 


Cosmetic injectables pros and cons 

It’s true that plastic surgery and cosmetic injectables have fairly comparable costs. But differences in results, longevity, recovery time, and need can help when you’re educating a patient. 

For example, dermal fillers can address the fat, muscle, and bone loss that can accompany aging. And we use several types of fillers to address volume loss. For patients under 50, we typically begin with these recommendations, often start with the midface and work with the client’s specific goals and needs to achieve the desired results.  

Facelifts, brow lifts, and blepharoplasty can lift the tissues and remove the excess skin but do nothing to address volume loss. Most facelift clients look more natural and refreshed with a little volume replacement once or twice a year. We often recommend to these clients continued care with neuromodulators to address the frown lines between the brows, the crow’s feet, and forehead lines.  


The new thread 

Thread lifts have reemerged on the scene recently. While there were many complications with the previously used products, the new threads are made from an absorbable suture that is fully absorbed by the body. The results can be natural and last up to a year. The procedure is minimally uncomfortable and works well in conjunction with neuromodulators and fillers for a more youthful and refreshed look. Again, if the sagging is significant and the skin texture is poor, the threads may pucker the skin and have minimal lifting capacity.  


Are you catching the common “thread” here? All of these treatments can have impressive results, but we have yet to find a nonsurgical treatment that can rival a surgical result for loose and sagging skin. Nonsurgical treatments are a great option for mild to moderate issues and can help clients look their best if they want to delay or are not candidates for surgery. 


Knowledge for your clients with PNAA  

With so many cosmetic injectables and plastic surgery options on the market, it can be overwhelming for clients. Our job as clinicians is to guide them and set realistic expectations. And to warn patients of those who promise surgical results with nonsurgical treatments. Our job is to remain a confident source of valuable information that helps clients make the best decisions for their skincare goals.