Combining BTX, Fillers And Thread Lift —
Three Causes, One Order

A combination face treatment is three answers to three different questions, not three treatments stacked for a bigger effect.

BTX relaxes muscle that is overactive: etched frown lines, a jaw squared by clenching, bands in the neck. Relaxing the muscles that pull the corners of the jaw down can also sharpen the jawline a little. See BTX for wrinkles.

Filler replaces volume where a fat compartment has genuinely emptied, such as a hollow temple or a deep tear trough. The face's fat sits in separate compartments that change at different rates, which is why filler is placed compartment by compartment rather than spread evenly. See dermal fillers.

A thread lift repositions soft tissue that has slipped a little, using dissolvable anchored threads to give a defined lift on the day. See thread lift.

Most faces past 40 show some of each cause, so the examination separates them: what has moved down, what has emptied, and what has loosened. The neck ages differently from the face and is assessed on its own.

The commonest mistake is treating a lifting problem with volume. A heavy lower face whose compartments are still full has dropped rather than deflated, and filler added there adds weight instead of lift. The opposite mistake is threading a face whose real problem is hollowness, which pulls on tissue that needs support, not repositioning.

Threads and energy-based lifting are partners rather than rivals. Threads give a defined vector straight away; energy builds collagen over weeks and improves the quality of the tissue the threads sit in. Threads fit a localised, mild to moderate slip in skin of reasonable quality; energy fits looser tissue over a wider area, or lays the groundwork for threads. At Atelier the energy option is the VF Lift – Vertical Facelift, which uses monopolar radiofrequency. Dr Sin Yong holds a Key Opinion Leader appointment with CLASSYS.

1. Lift first. Repositioning changes where the face looks empty. Volume placed before a lift is judged against tissue that is about to move, and can end up in the wrong place or simply add weight.
2. Volume second, once the lifted position can be seen, placed compartment by compartment in measured amounts.
3. Muscle refinement where needed. BTX can fit around the other steps. In the same area, BTX usually goes before filler, because a relaxed muscle changes how much volume the area seems to need; filler is then judged at the two-week check, once the toxin has reached its full effect.
4. Check before adding. Each result is assessed before the next step, and the sequence is reconsidered.

Can BTX and filler be given on the same day? In different areas, often yes, once the plan is clear. Whether a thread lift shares a visit with either depends on the areas, the products and how your face bruises, and is set at assessment rather than by a fixed rule.

A combined plan suits a face with more than one cause and a person who accepts a planned sequence rather than everything at once.

Better to wait during pregnancy or breastfeeding (see aesthetic treatments during pregnancy), with infection, inflammation or open spots where treatment would go, or when the hope is that injectables will replace surgery.

Not suitable, or needs careful assessment, with a neuromuscular disorder or medicines that affect nerve-to-muscle signalling (for BTX), an allergy to a product or thread material, a bleeding disorder or blood-thinning medicines, or an autoimmune or healing condition that raises the risk of the chosen route.

Referred on when descent goes beyond what non-surgical routes reach, or when the lower face or neck carries heavy excess skin; that is a plastic surgeon's assessment. How surgery and non-surgical options divide is set out in non-surgical facelift options.

Expected and temporary: bruising, swelling and soreness at needle or thread sites, and a heavy or tight feeling as BTX takes effect. Uncommon: asymmetry, a drooping eyelid or brow after BTX, lumps or an overfilled look after filler, a blocked blood vessel after filler, a thread that shows, dimples or moves, and infection. Choosing the wrong treatment for the cause is a risk in its own right, and response varies between people.

Risk is reduced by finding the cause first, sequencing, choosing dissolvable hyaluronic acid filler where appropriate, and checking each result before adding more.

Contact the clinic the same day for severe or worsening pain, skin that turns pale, mottled or dusky, any change in vision after filler around the eyes or nose, redness that spreads, warmth, discharge or fever, a droop that does not settle, or a thread that is visible or poking through. See vascular occlusion warning signs and thread lift complications.