When and How Should Facelift Surgery Be Revised?
3 December 2019 onur
Unfortunately, nothing can resist the march of time. Facelift surgery is no exception to this basic law.
Should facelift surgery be revised? If it will be revised, when and how? This post is written to answer the questions above.
First of all, let’s review the duration and permanence of the effect of facelift surgery. There is confusion about this. The effect of facelift surgery is permanent for life. In other words, even if you wanted to, you cannot reverse the effects of the surgery and you cannot destroy all the gains. The problem is that facelift surgery does not stop the facial aging process and naturally your face will continue to age after the surgery.
Facelift surgery also slows down the “gravity-induced sagging” step in aging in the long run after the surgery and prevents it to some extent. However, other mechanisms of aging such as volume loss, surface atrophy and bone atrophy continue at a constant rate without being affected by surgery. When the aging process progresses beyond the scope of the previous facelift surgery, it may be necessary to revise the surgery in order to maintain the effect.
The time to revise the facelift surgery depends on the type of the first surgery, the aging rate of the person and their expectations from life. Conventionally, only in facelift techniques by skin tension, the patient returns to a stage close to the preoperative facial form due to skin stretching. Even in this weakest link of facelift surgeries, 3-5 years of time between the first surgery and the second surgery will be to your advantage. However, considering current standards, we want the approaches we implemented that strengthen the deep plane and the SMAS layer to “hold” the face for at least 10 years.
What we mean by holding the face is not that you maintain the same appearance for 10 years, but that you stay in the 10% of the best-looking face shape among individuals in your chronological age group for 10 years after the surgery.
We typically perform the first facelift surgery on the deep tissue plane of the face between the ages of 40-55. In this surgery, the facial skin is mobilized as a block together with the soft tissue layer under the skin, which we call SMAS. Generally speaking, patients in this age group do not have surface aging at a level that requires the dissection of our skin from the SMAS layer. When surface aging becomes evident about 10-15 years after this first surgery, we can open the superficial surgical plane that we have left intact during the first operation and change the skin tension and the surface properties of the SMAS layer.
Secondary surgeries are performed on the same scar as the primary surgeries. There will be no additional scars on your face. However, the surgical dissection plane may be the same as that in the first surgery or it may be different. In my practice, in revision surgeries, the surgical dissection plane gradually evolves into a rather superficial plane.
For instance, if we performed a midface lift on a 35-year-old patient from the deepest subperiosteal tissue plane just above the bone, we would use the below-SMAS plane which is one step higher at 50 years old, and the above-SMAS/subcutaneous tissue plane which is one step higher at 65 years old. Therefore, mastery of all tissue planes in facial rejuvenation surgery is very important in the long-term management of patients.
One of the surgeries that is of particular importance for the revision of facelift surgery is mini facelift surgery. Sometimes, facelift surgery can be revised before the expiration date, as the desired effect cannot be achieved. In that case, instead of opening the whole face, the mini facelift approach may be adopted to make a few small reinforcements to the neglected points from the primary surgery. It heals faster, is cheaper and can be performed under local anesthesia.
In my opinion, it is a key detail for patients who are candidates for facial rejuvenation surgery to know the long-term strategy during the first surgery and to have information about the next steps before the first surgery in order for them not to burn the bridges. Thus, in our preoperative meetings, we are interested in the kind of strategy we will pursue in the long run as well as what we will do for you now. We are developing a long-term rejuvenation project for you.
Feel free to contact us for detailed information on the long-term course of facial rejuvenation surgeries as well as revision strategies.
Take good care…
… of yourself and your beauty.