Revision Facelift (Secondary Facelift Surgery)
3 December 2019 onur
Is facelift surgery performed only once in a person’s life? Is it repeatable?
You had a facelift, but things did not go well, so you are not satisfied with the result and you want it to be corrected. Is this possible?
Let me give you the answer now and do the explanation later.
Facelift surgery is a repeatable surgery, but it is often impossible to correct an improper facelift surgery.
Our patients who want to have a repeat facelift come up with 2 basic scenarios:
The first scenario:
The patient had a successful facelift years ago. In the years following their first surgery, they have naturally aged and some symptoms related to facial aging have recurred. The time elapsing between the first surgery and the second surgery is usually around 10 years. The patient is generally satisfied with the value that their first surgery brought to their life. Patients in this scenario often either return to the surgeon who performed their primary surgery or have been able to maintain close relations with that surgeon to get their recommendation for the secondary procedure.
In this scenario, facelift can be repeated with the technique employed in the first surgery or it can be repeated with a different surgical technique. For instance, we usually perform the first facelift “on the deep plane” for our patients between the ages of 45-55. In this age group, particularly in individuals who have taken good care of themselves, surface aging is still at an early stage. Surface aging becomes obvious within 10-15 years following the deep plane facelift. We can also plan a revision surgery on the superficial plane for this patient, whom we gave a deep plane facelift 10 years ago. Sometimes, even though it’s been over a decade since the first facelift, the face shape may be preserved very well. Patients only want a little touch-up. In such cases, we can make revisions with a mini facelift.
In revision facelifts, it is critical to have information about the technique employed during the primary surgery. This is because the technique used in the first surgery determines the technique of the second surgery. If the SMAS was excised or folded with permanent sutures during the first surgery, it will be risky to make a deep plane dissection in the second surgery. We generally prefer to perform revision surgeries on a superficial plane in patients whose primary surgery technique is unknown.
The second scenario:
The patient has recently had a facelift but is not satisfied with the result. Surgeries may sometimes be inaccurately designed or performed haphazardly in the hands of less experienced surgeons. Even experienced surgeons are sometimes influenced by the new techniques they see in congresses or read in scientific articles and they try techniques that they are not familiar with and that they do not routinely apply. Such trials on new experience do not always turn out as planned. For instance, the history of short-scar facelift is full of such disappointments.
In such cases, it may not be possible to correct the design or application errors from the primary surgery. For example, if the skin is excessively excised, stretched in the wrong direction or closed too tight, it is not possible to completely correct this in a revision surgery. It may not be possible to correct the cases where the excess skin is not well distributed over the length of the incision in the first surgery.
It is often impossible to change the incision site from the first surgery or to correct tissue shifts caused by the location of the incision site. For instance, as a rule, you cannot relocate a scar placed in front of the hair in the primary surgery to a place behind the hair during the revision surgery. If the temple hairline has moved too far back in the first surgery, you cannot bring this hairline forward again.
Reductions or damage in the SMAS layer of the face due to previous surgery cannot be repaired. If tissue circulation have been impaired and tissue losses have occurred in front of or behind the ear during primary surgery, they cannot be restored to their preoperative state. Sensory loss or losses in mimic movements from the primary surgery cannot be corrected. Volume imbalances due to excessive facial fat loss or excessive facial fat removal may not be completely eliminated. Surface irregularities, pits or bumps that occur due to getting too close to the skin during dissection in the primary surgery may not be eliminated in secondary surgery.
Particularly in patients who have had a midface lift, the excessively full and wide appearance in the midface area and on the cheekbones cannot be eliminated with a secondary procedure. If the Bichat’s fat pad or salivary glands were removed in the first surgery, these structures cannot be replaced.
Beyond these, patients often have extremely normal and naive but medically impossible expectations such as turning a bad facelift result into a good one or at least restoring to the preoperative state.
In some of the patients who applied with this second scenario, the result of the surgery was actually within the normal limits compared to the facelift, but it did not meet the patient’s high expectations. In this case, it would be an erroneous strategy to try to upgrade a previous facelift to meet the expectations of the patient. This is because talking and explaining in detail before the first surgery and taking the expectations of the patients within the limits of the surgery even in writing is the only way to secure a patient’s satisfaction with the result.
In the second scenario, from the surgeon’s perspective, you encounter a patient who has no realistic expectations, is initially unhappy and is often psychologically vulnerable. I personally wouldn’t want to work with a patient in this situation or take over a wreck. That is why I often reject revision requests from individuals who were not my patients during the primary surgery.
It is the patient’s responsibility to do research well and choose an experienced physician before the first surgery. You may still have complications although you choose a physician experienced in facial aesthetics. However, in that case, since your own doctor is already equipped to intervene with these complications, you do not need to turn to another doctor and you can solve relatively minor problems at relatively minor costs. Therefore, as in every branch of medicine, the choice of physician and the patient’s compliance with the treatment are key in facial rejuvenation.
Do not rush your decisions when it comes to your face, think carefully, gather information, visit doctors, read their CVs, see their surgical results and meet the patients who have been operated by them. In brief, do your own research well.
Take good care…
… of yourself and your beauty.