A revision facelift, secondary facelift or corrective facelift is a facelift procedure in a person who has already had a facelift. Dr Roth specialises in techniques that are tailored to particular problems that need to be addressed in a revision facelift procedure. A revision facelift is a very different operation to a primary facelift and the procedures typically needs to be carefully customised to the patient’s needs.
Why would a person need a revision facelift?
There are many reasons that a person may seek a revision facelift. By far the commonest scenario is when a person has had a successful primary facelift but have simply continued to slowly age over the 10 or so years since the first procedure. Other causes for a revision facelift include the following:
- Patients feel they did not get the results they were hoping for in the primary procedure
- Continued jowls, neck laxity, drooping cheeks or midface
- Patients feels the skin looks too tight and stretched
- Distorted ears
- Large, visible scars around the ears
- Hairline problems (loss of sideburns, step shaped hairlines behind the ears)
Over 90% of facelifts performed by plastic surgeons are what are called “superficial facelifts”. These facelifts lift the skin but do not adequately lift the SMAS layer beneath it. The SMAS is a fibrous and muscle layer extending from the cheeks all the way down into the neck to include the platysma muscle. If the SMAS is pulled by simply putting sutures in it (suspension sutures) the benefit is limited and short lasting. What follows is thin, tight skin rather than youthful full skin, wider scars, distorted earlobes (called a pixie ear) and often recurrent jowls, neck bands and excess droopy neck skin.
Another common problem is over-aggressive liposuction or other fat removing techniques in the neck. When the fat is removed from the central part of the neck (leaving a concave area) but the skin is not lifted from the sides (hanging jowls) it can look a little like a cobra’s head and is called a “cobra neck deformity”.
What is involved in a revision facelift procedure?
The first step is a detailed consultation to assess your face and neck. This will include assessing your skin and soft tissues and how they have aged. It will also assess what was done in the previous surgery and if any areas need to be corrected that resulted from this surgery. A revision procedure may need to include a browlift to help lift brow skin out of the outer eyes, a blepharoplasty (eyelift) procedure, ear reshaping or other specific issues such as scar revision.
The deep plane facelift technique is typically the safest and most effective technique to use in a revision procedure. By entering the deep plane and not raising the skin, further thinning of the skin is avoided. Once the deeper muscle of the face and neck are lifted, the old scars can be removed and new ones can be planned. If there is not tension on the skin around these scars the appearance is usually much better than during the primary surgery. Other issues such as a pixie ear or cobra neck deformity can also be addressed. A platysmaplasty is helpful for a cobra neck deformity.
The deep plane facelift does not tighten the skin primarily but focuses on tightening the deeper SMAS layer which was typically not done in the primary facelift. It lifts the SMAS and platysma muscle as one continuous layer. As this happens there is an improvement in the midface, jawline and neck.
The recovery from a revision facelift is not necessarily longer or more intense than a primary facelift. Superficial facelifts can cause significant bruising and swelling of the skin. This is usually avoided through a deep plane facelift.
Can we just remove the scars and restitch them to make them look better?
Some people are very pleased with the outcome of their facelift but not with their scars. Prominent scars occur because the skin was closed under too much tension. If you simply remove the scar and restitch the skin (a scar revision) it will then be closed under even more tension leading to a potentially worse looking scar. The only way to make bad facelift scars look better is through a revision facelift procedure that lifts the deep tissues, take the tension off the skin then allows the old scars to be removed and new scars be positioned with no tension.
Cobra neck deformity. Note the central hollowness and hanging jowls on either side. This occurs from too much fat being removed under the chin without addressing the vertical platysmal bands on either side.
Pixie ear deformity. This occurs from too much skin tension in a facelift. It can be corrected through a revision facelift procedure.