When it comes to facial rejuvenation, Wayne, NJ facial plastic surgeon Jeffrey Wise, MD believes the best outcomes come from looking at the full picture. “When a patient seeks consultation for facial rejuvenation, a comprehensive medical history is critical, as well as the patient’s aesthetic goals and lifestyle,” he says. “It’s also important to consider whether they have time in their life for potential downtime from a procedure.”
That foundation helps him build a completely customized roadmap, whether it includes injectables, laser devices or surgery—or often, a combination of all three.
Where Technology Fits In
For patients who aren’t quite ready for surgery, Dr. Wise says energy-based devices can be a great starting point. “Frequently, patients who are not psychologically or aesthetically suited for surgical procedures begin their aesthetic journey with less invasive devices,” he explains. “We’ve recently upgraded our Ultherapy and Morpheus8 devices, and with the newer technology, we’re seeing exciting results with minimal downtime.”
But he also sets realistic expectations. “At some point, some of these devices produce underwhelming results for patients with more significant signs of facial aging,” he says. “That’s when a surgical procedure becomes the optimal remedy.” Even after surgery, he often recommends periodic maintenance with ultrasound or radiofrequency. “We liken it to buying a nice car and then changing the oil periodically to keep it running optimally.”
Injectables Aren’t Replacements
While injectables like neurotoxins and fillers are powerful tools, Dr. Wise cautions that they aren’t a substitute for surgery. “One of the biggest misconceptions is that injectable treatments can be completely replaced by surgical procedures,” he says. “That’s just not the case. We frequently use both noninvasive and surgical procedures as a synergistic approach to facial rejuvenation. Realistically, there are things that neurotoxins and fillers can do that surgery cannot—and certainly, the opposite is true as well.”
Facelift Plus
Dr. Wise rarely approaches a facelift as a standalone treatment. “Many adjunctive procedures are commonly employed during a facelift, depending on the patient’s needs and goals,” he says. “A facelift, at its essence, is outstanding for jawline and neck contouring. However, some patients require volumization, and fat transfer is a great long-term, natural remedy for that. Others may have aging skin issues like brown spots, fine lines or wrinkles, which can be excellently treated with laser resurfacing.”
In some cases, he also performs eyelid treatments or chin implantation to further enhance the result. “It’s about combining techniques to deliver a natural, comprehensive transformation.”
Avoiding the Overfilled Look
With more patients turning to injectables earlier, Dr. Wise often sees signs of overtreatment. “Too often, we see fillers used in excess to accomplish goals that would be better achieved with facelift procedures,” he says. “This creates an unnatural or overly filled look.”
He stresses that while fillers have an important role, they shouldn’t be pushed beyond their limits. “There is a fantastic role for volume restoration with fillers, but when those have been optimized and no longer provide suitable results, it’s time to pivot to surgery,” he says. “During a facelift, we often use autologous fat transfer to enhance jaw and neck contouring, and to restore volume in a way that looks natural and age-appropriate.”
A Long-Term Mindset
Whether someone is just beginning their aesthetic journey or looking to refresh previous procedures, Dr. Wise believes longevity comes from balance and maintenance. “Even after a facelift, I’ll often counsel patients on how to maintain their results over time,” he says. “Just like taking care of a car, you don’t stop once you’ve made the investment. It’s about staying consistent with maintenance, not overdoing it.”
