Question 1

What’s a revision facelift?

Accepted Answer

Facelift revision surgery (aka a secondary facelift or rhytidectomy) is performed for a variety of reasons. This type of facial plastic surgery can:

correct complications from a previous facelift procedure
improve an inadequate outcome, often in cases where the primary procedure removed only excess skin, without lifting the underlying SMAS layer (which ensures longer-lasting facial rejuvenation)
restore facial rejuvenation results that have degraded over time—usually after about 10 years, when the tissues have stretched and fallen, and patients are again beginning to notice jowls, jawline laxity, and loose neck skin

According to Dr. Jill Hessler, a board-certified facial plastic surgeon in Palo Alto, California, common reasons people request revision facelifts include:

neck banding
too much fat removal from the neck, leading to a condition called a cobra neck deformity
residual jowling, laxity, and/or buccal fat fullness (an undertreated face)
flat or fallen cheeks
visible scars
a swept-back or stretched appearance
asymmetry
distorted ears and earlobes (misshapen tragus and pixie ear deformity)
hairline distortion (due to poor incision design)

Related: 5 Signs of a Botched Facelift

Doctors on RealSelf say you should wait at least one year after the original facelift before considering revision surgery. This allows the tissues to fully heal, swelling to resolve, and any scar tissue to mature, which makes it easier for your facial plastic surgeon to evaluate your concerns and make the appropriate treatment plan to address them.

“When having a revision, you want to minimize the risks as much as possible. Sometimes waiting a little longer means a reduced risk of problems,” says Dr. Amir Nakhdjevini, a plastic surgeon in Royal Tunbridge Wells, England.

Don’t worry that a second facelift will somehow be “too much” for your face. “Women can have multiple facelifts over a lifetime without issue—as long as they’ve chosen a good plastic surgeon and have had the proper technique performed,” says Niles, Illinois, plastic surgeon Dr. Sam Speron.

That being said, having a series of facelifts does increase your risk of a distorted appearance. Choose a highly experienced, board-certified plastic surgeon or facial plastic surgeon to perform any revision procedure.

Question 2

What are the pros and cons of facelift revision surgery?

Accepted Answer

Pros

Revision facelift surgery can correct issues from a prior procedure and restore a more youthful, natural appearance.
Studies have shown that patients are more satisfied with secondary facelift results.
Most healthy adults who’ve had a previous facelift are good candidates for a secondary procedure.
The complication rate after a secondary facelift is 5%, about the same as with primary facelift surgery, according to a review study of 811 facelifts that included 60 secondary procedures. “In contrast to some reports, there was no increase in the rate of facial nerve injury after secondary facelifts,” the study authors reported. (Of course, rates vary by surgeon and technique.)
Depending on what was done initially, secondary facelifts may not be as extensive as first operations, says Frisco, Texas, facial plastic surgeon Dr. Matthew Richardson. In those cases, “the recovery is similar—but often easier and shorter.”

Cons

“While the recovery and complications can be similar in primary and revision surgery, the anatomy can be more complex in revision surgery, as some of the tissue planes are altered,” Dr. Hessler explains. “You want to make certain you visit a facial plastic surgeon who is knowledgeable and skilled in revision surgery and the complex facial anatomy.”
You’ll have to wait about a year between a primary facelift and revision surgery, to allow the swelling to resolve and scars to mature.
The worst of the swelling normally goes down after 48 to 72 hours, but it can take up to two weeks to look “restaurant ready.” This is especially true if other procedures—such as brow lift, blepharoplasty, fat transfer, or laser skin rejuvenation—were also performed, says Dr. Hessler.
As with a primary facelift, it can be six months or more before you see the final results of your revision procedure.
Facelift revisions require a true specialist who’s comfortable navigating non-virgin tissue—the altered anatomy and scar tissue created by primary surgery—and these surgeons typically charge a premium for their expertise.
Other potential complications include hematoma, seroma, infection, and a need for further revision.
While some surgeons waive or discount their fee to correct complications or unsatisfactory outcomes from a previous procedure, you’ll still have to pay for the operating facility, surgical supplies, and anesthesia.

Question 3

How much does a facelift revision cost?

Accepted Answer

The price you pay will depend on your surgeon’s level of experience, their practice location, the extent of your procedure, and the type of anesthesia you receive. The most experienced, in-demand facial plastic surgeons often charge upwards of $60,000 for revision facelift surgery.

If you’re comfortable returning to your original surgeon to fix complications from your prior facelift (that aren’t due to you not following aftercare instructions), they may reduce or waive their surgical fees. Your surgeon should have reviewed their policy on revisions with you prior to your original surgery.

Question 4

Facelift revision before and after pictures

Accepted Answer

The facelift revision photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.

Question 5

Are there advantages to returning to the same surgeon for your revision facelift?

Accepted Answer

There can be benefits to returning to your first surgeon for your revision, especially if you were happy with the results of your first facelift for many years and just need a bit of a refresh.

Even if you aren’t pleased with your results, it can be useful to start by getting the opinion of your original surgeon. “Discuss your concerns with your surgeon and ask them what they perceive about your results, since they have your preoperative photographs,” says Jacksonville, Florida, facial plastic surgeon Dr. Scott Trimas. Ask your surgeon to print your before and after photos so you can both review the images and come up with a plan to improve your results.

One RealSelf reviewer reported that not only did her original plastic surgeon address her concerns without charge, but “he even fixed a few little blips that he didn’t like that I hadn’t noticed.”

Related: What Should You Do If You Don’t See the Results You Want Post-Procedure?

If you’re not comfortable returning to your original surgeon or they’re not responsive to your concerns, ask the office for your records, so your new surgeon can review them.

When choosing a surgeon to perform a secondary facelift, look for a board-certified plastic or facial plastic surgeon who has vast experience performing revision facelifts, with an extensive before and after photo gallery to show for it.

“Ask how many facelift surgical procedures they do in a week, a month, or a day,” Dr. Hessler advises. “You want a surgeon who is not racing through to complete multiple surgeries in a day, but you also want a surgeon in which the majority of their practice is facelifts.”

“Most of the time, revision plastic surgeries require a greater degree of precision than the original procedures, simply because they necessitate an understanding of how the tissues have already been altered and affected by previous surgeries,” explains Dr. Paul Nassif, a facial plastic surgeon in Beverly Hills, California. “Care must be taken not to disrupt the underlying structures of the face in a way that would result in excessive scarring, issues with the nervous or lymphatic systems, or undesired aesthetic results.”

Question 6

What does a revision facelift procedure involve?

Accepted Answer

There’s no single best surgical technique or treatment plan for a secondary facelift. Your treatment plan will depend on your concerns, goals, and budget, as well as your surgeon’s recommendations and technique.

A minor touch-up

If aiming to counter the effects of the aging process on your primary facelift results, some surgeons say a mini lift may suffice. The procedure addresses most of the same issues as a traditional SMAS facelift, except for lower neck laxity, and typically uses shorter incisions, so there can be as much as 40% less scarring than with a full facelift (hence the reason it’s also known as a “short scar facelift”).
If your lower face has fared well over time but your neckline has relaxed, then a neck lift may be the most appropriate fix.
If your primary facelift left you with poor scars, misshapen ears, or an odd bump, pleat, or divot, your surgeon may be able to fix these side effects in the office under local anesthesia, assuming they’re not too severe.

A more dramatic lift

Facial plastic surgeons commonly revise SMAS facelifts that failed to adequately address the midface or jowls. In such cases, a deep plane lift is typically performed under general anesthesia or IV sedation. The surgeon will go under the SMAS layer to release key ligaments and reposition fallen tissues before trimming away excess skin.

Expect your recovery to be as long (or longer) than that which followed your primary facelift.

Complementary procedures

If your primary facelift results—your jawline and neck—have held up well, but you’re seeing other age-related changes that bother you, ancillary surgical or nonsurgical procedures may give you the results you’re after.

A lateral or temporal brow lift can reposition a fallen brow while taking weight off the outer corners of the eyelids. A more invasive coronal brow lift—with an ear-to-ear incision hidden behind the hairline—can elevate the forehead more completely (and adjust the height of the hairline, if need be).
A blepharoplasty can remove excess skin and fat from the upper and lower eyelids.
A rhinoplasty can have a rejuvenative effect on the face by smoothing harsh contours that have revealed themselves with age, while lifting a droopy nasal tip.
Injectable fillers or fat grafting can add volume to the midface, temples, and under eyes, while stem cell-rich nanofat injections can help improve skin quality.
Laser resurfacing or chemical peels can tackle sunspots and fine lines, for a more pristine canvas.
Botox injections can soften and prevent recurrent neck bands.

To avoid disappointment, discuss all your concerns with your plastic surgeon to determine if—and to what degree—they can realistically be addressed.

FACELIFT REVISION

Jill Hessler, MD

Karyn Repinski

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Jill Hessler, MD

Karyn Repinski

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