Neck/Face Lift Revision: Am I at higher risk for skin necrosis re-occurrence?

I had a neck lift and lower face lift 7 months ago and have some areas that need improvement. At the one year mark I will be considering having a full revision with incisions in front of/behind the ears, as well as at the submental incision again. (Same as original surgery) I had some skin necrosis occur behind one ear after the original surgery. Am I at higher risk for more necrosis after the revison? Also, are muscles always pulled again during revison or can it be a skin only revision?

Doctor Answers 10

Neck/Face Lift Revision: Am I at higher risk for skin necrosis re-occurrence?

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If you wait a year before having another surgery you should not be at a high risk for more skin necrosis. Techniques do vary during revision facelifts. It depends on what you want to achieve. Do you have residual looseness from your original surgery? Are there any asymmetries? Discuss these topics with your surgeon, in addition to the scars from the necrosis, to determine which technique would benefit you most. Good luck.


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Would definitely wait 1 year before considering revision, however what you have done at the revision will depend on many factors.  Are you interested in achieving more lift?  Are you looking for a scar revision?  Was there a specific reason for the necrosis like smoking or are you diabetic?  I would have an in depth conversation with your surgeon prior to embarking on the revision because the risks maybe different than what you discussed originally.

James Chan, MD
Portland Facial Plastic Surgeon
4.9 out of 5 stars 58 reviews

Necrosis reoccurrence?

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Thank you for your astute question.  You are not at higher risk of skin necrosis as long as good technique is performed with elevation of you skin.  Best of luck. 

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Facelift scar revision

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I agree with waiting about a year prior to having revision facelift surgery. It is highly unlikely to sustain flap necrosis in a revision surgery with proper technique and follow up treatment.

Patients are at lower risk for skin necrosis when undergoing scar revision after a facelift.

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Because of the development of collateral circulation to the areas close to the skin necrosis revision will surgery is seldom complicated by wound healing issues. Inflammation should be completely subsided before this revision is undertaken.

Recurrent necrosis

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It all depends on why you had necrosis. Some necrosis at the distal end of the flaps is always a risk due to the nature of the surgery. Smoking or nicotine use has a very strong effect on the blood supply and can increase the risk substantially. Tension is also a risk factor. Before just redoing a procedure that fell short of your expectations be sure the problem creating what you don't like is appropriately diagnosed. It could be due to lack of volume in the appropriate places, poor skin quality (especially true with patients in their 60s and older), or under-correction at the time of the initial surgery. Pulling tighter sometimes can potentially create problems giving some of the classic stigma of a bad facelift if laxity is not the problem. 

Skin that has been lifted before would actually be heartier the second time around and should actually heal better unless adding more tension is a problem.

Good luck,

Secondary Face Lift

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Touch-up facelift procedures are usually performed to treat specific problems and may be skin only. It just depends on the problem being addressed. The skin necrosis question is difficult to answer without more information. Was nicotine of diabetes involved? Oftentimes after a year delay, the circulation to the skin will actually be better than the first time. These questions should be discussed with your surgeon who knows you and is familiar with the necrosis issue .


Revision facelift

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If you had skin necrosis behind the ear the first time then certainly you are higher risk again. Your surgeon will have to be very conservative. 

In revision facelift usually muscles are also tightened.


Dr. J

Risks for skin necrosis in Neck/Face Lift Revision

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The major factors for skin necrosis in facelifting are related to factors such as the degree of undermining of the tissues, the plane in which the dissection is taking place and the amount of tension used in tightening the skin. There is always a fight between the benefits of better outcome with more extensive surgery versus the risk of damage to the blood supply of the tissues; therefore the more the extent of undermining, the more the risk but less undermining can also correlate with less improvement. Sometimes dissection is carried out in more than one plane which of course adds to the injury of surgery to the tissues. 

I have undertaken many revision facelifts though usually this is after a longer period of time than for yourself; as there will be scarring present from the previous surgery then the risks of bleeding are potentially greater though if a different plane is chosen or available then that risk is slightly reduced. More bleeding increases risks to the blood supply of the skin and so the risk of skin loss. The main tension in the lift should be placed in a deeper plane such as the SMAS (a fibrous more inelastic layer deeper in the face); it can be placed in a different direction to the direction of pull or vector in the skin and the combination of differing vectors in different layers tends to even out to then give the most natural result. It is important to place the tension then in the deeper layer, thereby minimal tension is needed in the skin itself which then in turn minimises the blood supply damage to the skin and so risk of skin loss in the skin. I used to use a compression garment or dressing to try to 'press on the skin' with the idea that this could stop bleeding but I no longer do so as for me if I am happy with the surgery and happy that I have stopped any bleeding at the operation itself then I would not want or need to put any pressure on the skin at all; no dressing means that the condition of the skin is visible and any problem with the blood supply is apparent early and if necessary can be immediately addressed. 

There are also external factors in the risks of skin loss - smoking is the most obvious one but other medical conditions can play a role.

The choice of whether the muscles are pulled again in revision depends on what is the aim of revision; I would only say they are pulled again if the first procedure did not pull them appropriately or sufficiently.

Yes it is possible to undertake a skin only revision but see above about how much and when the skin should be undermined and pure skin surgery will still risk skin loss if the tension in the skin is too great.

I would discuss these points with your surgeon; to summarise what is the aim of the revision, consider which plane or planes are being dissected, how to minimise tension in the skin, avoid external factors such as smoking or pressure on the skin so care in the bandaging or no bandage. 

I hope that is helpful and my best wishes for your secondary adjustment.

Tariq Ahmad, MBBChir, FRCS(Plast)
Cambridge Plastic Surgeon

What's involved in a facelift revision

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What you are talking about having is an early revision.  This usually means correcting some issues at about 1 year after surgery once you have made it through the initial healing phase.

Early revisions may be needed for a variety of reasons.  It is not possible to answer your questions without knowing which specific issues you are seeing or are concerned with.  Sometimes muscle tightening is part of the plan.  In other cases you may only be dealing with skin, and in other cases it may be a combination of several issues. 

Your surgeon would be the best person to advise you about the skin necrosis concerns.  That is always a potential risk with any facelift procedure, but without knowing more about your history it is not possible to truly tell if you would have a higher risk with this next procedure.

David W. Rodwell III, MD
Charleston Facial Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.