I see hundreds of Facelift patients every year who ask me to hand them back the once youthful characteristics of their face. No matter their chronological age, they feel great and they want the outside to reflect their youthful spirit, high energy level and natural vibrancy.
In my practice, every Facelift procedure I perform is customized to address the extent of aging, as well as my patient’s extremely unique needs and desired results. Each patient shows different and varying degrees of facial aging based upon their genetics, health and lifestyle as well as sun exposure. I see some patients in their 60s who look like they are 40 and some in their 40s and 50s who look at least 10 years older than their actual age. The bottom line is that no one Facelift technique can restore a youthful appearance to all men and women seeking Facelift Surgery or Revision Facelift Surgery. In all cases, it takes a customized approach and outstanding surgical skill to produce the best results.
The most common reason patients seek my help is due to minimal, short-lived results from their initial Facelift Surgery with another surgeon. Prospective Revision Facelift patients also sometimes require revision surgery due to complications resulting from surgical error on the part of their previous surgeon, but many times revision is required due to an improper Facelift technique.
In the past eight years or so, numerous new Facelifts have been heavily marketed to the public such as the Thread Lift, Silhouette Lift, Feather Lift and String Lift Facelift. In fact, we now see these Facelift procedures do nothing for the patient over time producing extremely short lived and often unnatural results. For the most part, these Facelift procedures do not lift muscle tissue; they only pull skin. They include suture suspension techniques, Gore-tex slings, and suture banding. Nonetheless, surgeons employed these facelifting techniques on patients who were better candidates for Deep Plane, SMAS or SLUPlift™ Mini Facelift, all which address underlying muscle. They may have persistent jowling, neck sagging, uneven platysmal banding, poorly placed incisions around their ears, temporal hair loss due to a temporal incision, pixie ear deformity (where the corner of ear is pulled down and unnaturally meets the face), dimpling and irregularities in the area of the face and neck.
There are a number of challenges a surgeon faces while performing Revision Surgery on a patient he/she did not previously operate on. And some underlying problems or existing complications are only visible once I begin surgery, while some are immediately visible to me when the patient walks into my office. Complications can include:
- Left over sutures from a Thread Lift or String Lift patient, which need to be released and removed during revision surgery.
- Tissue planes (area dividing tissue types such as muscle and fat) were poorly dissected and “false planes” were created. This tissue should not have been cut due to proximity to nerves where potential nerve trauma or damage is possible.
- The SMAS muscle was not dissected, trimmed and/or tightened properly leading to persistent sagging and an unnatural look.
- The submental fat pads (area directly under the chin) were not addressed leaving the jowl and neck area to look 10 years older than the face above it.
- The platysmal bands were not correctly plicated. Platysma bands are thin neck muscles that separate and lose elasticity with age creating unsightly vertical folds.
- Visible scarring. Scar tissue formation is the body’s normal healing response, so incision location is critical. If there is visible scarring from a previous surgery, this initial scar should be excised and re-sutured.
- The incision was placed in the hairline, which is a problematic area for reasons discussed below.
Many patients ask me how many Facelifts they can have in a lifetime. Can they have a second one after 10 or 15 years have passed and a few signs of aging have returned? The answer is yes, they can have a second Facelift procedure but results will in part be based upon whether the initial surgery was done correctly. Some surgeons tell their patients “no” to this question: they can have one, two at absolute most, but a second surgery should be avoided. Sounds reasonable to dissuade patients from even more surgery, until you discover the underlying reason for the answer. This answer is often the one a patient will get from a General Plastic Surgeon who employs temporal hair incisions during Face Lifting Surgery. With a Temporal Hair Incision Facelift, the patient’s natural hairline is pulled back from its natural and original position once the skin has been trimmed. The Plastic Surgeon believes he/she is hiding the incision well, when, in fact, a pulled back hairline and hair loss are the part of the end result. A second Facelift with this incision will result in the hairline being pulled back even further which is an obvious, unnatural and telltale sign of Plastic Surgery. This unsightly complication is better avoided with the incision placed in the Pre-Tricheal or preauricular hair tuft area during the initial surgery, which a trained and experienced Facial Plastic Surgeon can achieve. With this incision, the hairline stays in the original position and only loose skin is trimmed. This avoids potential scarring in the temporal hairline and loss of hair in the temporal area. Temporal incisions leave patients looking like they have been through a wind tunnel.
Pre and Post-tragal Incisions
The Tragus is the cartilaginous part of the ear that faces backward and covers the entrance to the ear. The pre-tragal area is directly in front of it. The natural skin crease follows the tragal area, making it an ideal location for incision placement. This incision heals within a previous skin crease making it imperceptible Some surgeons will place facelift incisions inside the tragal area or post-tragal, which ends up with an ear appearing strangely pulled forward and with the opening of ear getting much bigger than it was prior to surgery. This is best avoided as the ear appears distorted and unnatural. This also contributes to the infamous “wind tunnel” look.
Complications Which Revision Facelift Surgery Cannot Address:
Sensory and Motor Nerve Damage
I am able to help a majority of the patients who see me for Revision Facelift surgery and they enjoy natural and long lasting results. There are, however, circumstances where a Revision Surgery will not reverse a complication from the patient’s initial surgery. A complication that is not reversible is nerve damage where the nerve has been severed during surgery.
There are both sensory and motor nerves in the face. The greater auricular nerve is a sensory nerve than supplies innervation to the area of the lower and back of the ear. This nerve is very close to the skin and is the most commonly traumatized or injured nerve during Facelift Surgery. If this nerve is cut, then permanent nerve loss is almost definite. Most commonly post-operative numbness exists two to four months following surgery this is because the skin has been lifted, with nerve endings detached so it takes some time for the nerve endings to regenerate and grow back. The good news is that this numbness does resolve a revision face lift would not reverse/address the numbness, whether numbness is permanent or not. Revision facelift is not indicated in either case.
The marginal mandibular nerve, which controls the corner of the mouth, is the second most commonly injured nerve. If severed, the patient will show persistent drooping of the corner of the lip area. If traumatized but not severed, there will most likely be temporary motor nerve loss at the corner of the mouth lasting 24 hours and up to two and three weeks, yet motor function will return. Should motor function persist over a period of more than 18 months, then permanent damage may have been done. This would be a permanent complication of face lifting surgery.
There are revision techniques, which are highly marketed as a new and comprehensive technique to revise previous Facelift Surgeries; beware of anything “new” to completely “redo” a previous Facelift. There may be only one area that needs to be addressed. It is essential to choose a Board Certified Facial Plastic Surgeon who has been rigorously trained in Facial Surgery and has the experience in performing Cosmetic Facelift and Revision Facelift Surgery.
Dr. Oleh Slupchynskyj is a renowned Facial Plastic Surgeon New York City patients trust to deliver sophisticated treatments and natural-looking results. Dr. Slupchynskyj is Board Certified in Head and Neck Surgery. In addition to offering aesthetic procedures such as Facelift, Brow Lift and Eyelid Lift, he performs advanced Facial Reconstructive Surgery to help patients who are unhappy with their appearance due to birth defects, deformities, or facial trauma.
Revision Facelift Following Thread Lift
The above is an intra-operative photo depicting a patient who had undergone a previous Facelift with another surgeon, specifically a Thread Lift. Note the arrows and the areas to which they point. These areas show ends of “threads” used in her Thread Lift that have been retained in the tissue. In addition, you can see scar tissue around the threads that appear as white colored tissue.
Dr. Slupchynskyj performed Revision Facelift Surgery on this patient, employed his SLUPlift™ technique and removed the “threads”.
Thread Lifts were first performed approximately ten years ago, and several surgeons developed the procedure. The thinking at the time was the threads could be placed in the patient’s subcutaneous tissue, brought out through stab incisions and basically pulled up and sutured in the back of a neck, acting much like a purse string. Unfortunately, several complications resulted as reported in numerous clinical studies.
First, the threads are permanent and this leads to scar tissue in and around the threads. Second, the threads pull soft tissue, fat and skin only. This translates to results that are short-lived, as the procedure does not address the underlying muscle. Jowling will continue regardless of skin and soft tissue being pulled up. Bunching of the skin can also be seen in some patients.
Revision Facelifts can be performed in patients who have suffered complications of a Thread Lift and their outcomes are good. The retained suture material (threads) must be carefully removed from the subcutaneous tissue. If the threads are embedded, removal could incur damage to the surrounding sensory and motor nerves, arteries and veins. In this case, threads are typically left in place.
While Thread Lifts are still performed today, the consensus among qualified and experienced Cosmetic Facelift Surgeons is that this type of Facelift is to be avoided.