Facelift or Botulinum Toxin?

These are often presented as alternatives. They are not. They treat different things, and the reason a patient is unhappy with their face determines which of them is relevant.

What a facelift addresses

A facelift is a surgical procedure that addresses the visible signs of descent — sagging skin, jowls, deepening nasolabial folds and loose skin in the neck. Modern technique is considerably less invasive than the operations the term still evokes.

The focus is the lower face: the cheeks and jowls. The forehead, brows and eyelids sit outside a facelift’s reach, which is why it is frequently combined with a brow lift or eyelid surgery when the upper face is also a concern.

Recovery runs to two to four weeks. Swelling and bruising reduce over the first few days with the head kept elevated; most patients return to non-strenuous work in the second week; strenuous activity resumes at around a month.

Results are measured in years rather than months, the operation can be tailored to the individual anatomy, and several areas can be addressed in one procedure.

What botulinum toxin addresses

Botulinum toxin is injected into specific facial muscles, where it blocks the nerve signals that make them contract. Relaxing the muscle softens the lines that repeated contraction produces. The usual targets are the forehead, the frown lines between the brows and the crow’s feet at the outer eye. It is also used in the treatment of excessive sweating.

It is non-surgical. There is no incision, no suturing and no recovery period, and normal activity resumes immediately. Discomfort is minimal — a fine needle — and treatment takes under thirty minutes.

The effect lasts around three to four months. That is a limitation, but it is also useful: it allows a patient to see what a change looks like on their own face before committing to anything permanent.

Choosing between them

Botulinum toxin addresses mild to moderate dynamic lines. A facelift addresses skin laxity and descended tissue. If the problem is a line that appears when you move, the first is relevant. If the problem is present when your face is at rest, the second is.

That assessment — taking account of age, skin quality, where the lines sit and your general health — is what a consultation with a board-certified plastic surgeon is for.

Combining them

Botulinum toxin is often used alongside surgery, because it treats something a facelift does not. The standard advice is to wait four to six weeks after a facelift before injectables, so the tissues have healed first.