Fill vs. Lift in Facial Cosmetic Enhancement

This article is a corollary to my other article called the “Two-Finger Rule”. In the article on the “Two-Finger Rule”, I argued that taking two fingers and gently pulling up on the skin would not be achievable with any type of cosmetic procedure since it cannot be exactly reproduced by any lifting or filling technique. Similarly, when a patient asks me whether filling a part of the face in will help to lift that structure up I respond simply, “No.” The two are not the same thing. Filling a part of the face will not lift it and if it is reasonably filled up also should not make it heavier to create any sagging.

The most common question is if I fill the cheek in will that lift the smile line.  The answer is emphatically no.  It won’t.  Sometimes just filling the cheek in can cast a greater shadow on the fold and at times make it appear deeper but not substantially so.  It seems intuitive that if you enlarge something that it would stretch out the areas around it to lift it but this simply is not the case.  I had also a question on my forum that if an injectable filler could be placed near the bone so that it would provide more structure as compared with placing it close to the skin where it would add more weight.  I countered this by explaining that a filler placed deeply should not provide better structure and one placed close to the skin should not provide greater weight.

This patient had facial fillers to fill areas of hollowness. Even though the face looks lifted, it is an optical illusion of the filling.

The optical illusion that is created is that something filled in changes the way that light reflexes on it making it look lifted just by virtue that there is now more light and less shadow on the structure.   But there is no net lifting effect.  In summary, this article is intended to dispel a misconception and to provide a better understanding for a prospective patient that filling fills and lifting lifts but one does not help the other.

Sam M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. Call 972.312.8188 to schedule a consultation or to ask Dr Lam a question about facial rejuvenation procedures please visit his plastic surgery forums.