September 2023

4 Telltale Signs of
A Bad Facelift

4 Telltale Signs of A Bad Facelift

While the old adage "don't judge a book by its cover" is wisdom to live by, our faces and facial expression can make a lasting first impression. Our faces can communicate frustration, approachability, and trustworthiness, and a facelift procedure can either compliment or betray the appearance we want to show the world.

A facelift is a delicate procedure with little room for error. It's not always easy to spot a great facelift, but it's always obvious when you see a bad one. When something isn't "quite right" with the way your friend or loved one looks, you begin searching for signs to confirm your suspicions.

It's why, when considering facelift surgery, you should thoroughly verify your choice of plastic surgeon. While most signs of a bad facelift can be corrected with a revision facelift, I'm sure we can all agree that it's best to get it done right the first time.

That said, here are the top 4 telltale signs of bad facelift results and what an experienced plastic surgeon can do to address them.

Here Are Your Bad Signs

Appearance of Scars

In facelift surgery, loose and excess facial skin is removed to reveal better midface and jawline definition. Facelift scars are designed to be well-concealed, even when wearing your hair back or up. Most facelifts trace the hairline into the anterior (front) ear crease, go behind the ear “bump” or tragus, and go to the base of the earlobe, behind the ear, and into the back hairline above the neck. Distinct scar lines or widened facelift scars in front of the ears are indicators of a bad facelift.

Visible scars and balding

Failure to properly place the incisions correctly within the hairline at the temples can lead to elevation of the sideburns. This gives an unnatural and artificial-looking hairline and leaves a bald spot around the top of the ear.

Scars that are made too tight

An overly tight skin closure can pull the scar away from the ear and onto the face often resulting in a wide, unsightly scar. Tension should always fall on the deeper tissue called the SMAS. The skin itself should be closed with little to no tension.

Pixie Ears

The skin around the earlobe should also be under no tension. If this closure is too tight the earlobe can become attached to the skin and pulled forward onto the face. This is called "Pixie Ears" and can only be fixed by re-elevating the skin around the earlobe and resetting the earlobe.

A stair-step of skin behind the earlobes

Incisions behind the ear can become red and raised. These can be treated with laser and steroid injections. In some cases, the hairline does not perfectly align resulting in a stair-step deformity of the posterior hairline.

The FIX:

Most will require some form of formal revision, usually in the operating room. Wide or poorly healed scars require removal, re-elevation of the skin, some off-loading tension transferred to the deep layer (SMAS), and resuturing under less tension. Bald spots can be impossible to be relocated but small hair transplants can be very effective. Modern hair transplants use a technique where each individual hair follicle is transferred using “follicular unit extraction.” Pixie earlobes need both elevation of the earlobe and re-attachment to the face with a small space between the earlobe and facial skin: unattached earlobe. Poor hairline alignment usually requires re-elevation of the posterior flap and excision or removal of the uneven hairline.  

pixie ear deformity and facelift scars  after a bad facelift


The Lift & Fill Facelift:
Natural Results That Last

Lift & Fill
Trout Mouth, Signs of a Bad FaceliftTrout Mouth, Signs of a Bad Facelift

Poor Facelift Design

The direction of pull is crucial in achieving a natural facelift and avoiding distortion. Facelifts that are pulled up too much (as in vertically) can result in bunched-up skin around the lower eyelids and/or a narrowing of the distance between the eyelids. Facelifts pulled too laterally can appear “wind-swept” and distort the corners of the mouth. Some refer to this as look as "trout mouth."

It's critical that your plastic surgeon execute a proper vector of pull to create a natural result. The vector will depend on a number of factors, thus getting a great facelift is never a one size fits all design. Generally, in the upper face, the vector is more oblique, or angled towards the upper ear (helical root) while the vector at the neck is created in a more horizontal pattern to tighten the skin and create a more contour.

The FIX:

Poor facelift design requires a complete revision or re-do. The facelift skin must be re-elevated and the SMAS vector re-established in the correct orientation.  

Odd or Impaired Facial Movement

Unfortunately, damage to the facial nerve can occur when a plastic surgeon has not been thoughtful and careful in dissecting the deep layers of facial anatomy. Facial nerves live with the deeper facial tissue and facial muscles. Inexperienced surgeons who are unfamiliar with the layers of facial anatomy can unknowingly and permanently cause nerve injury.

The facial nerve has 5 branches and impaired facial movement can result from damage to any one branch. Nerve damage is typically detected when a facelift patient has difficulty raising their eyebrows or depressing the lower lip. In cases where neuropraxia, or nerve stretching, occurs, the nerve itself can recover. In other cases, the nerve might have been cut and won’t recover.. 

The FIX:

Damage to a facial nerve might be reversible if caught early enough. If the nerve was cut the 2 ends of the nerve should be repaired. If the nerve is trapped in plication sutures then releasing the sutures should help. After months the fix is much more difficult and would require a microsurgery procedure called facial reanimation

odd or impaired facial movement after a bad facelift

Before and After Facelift Results by Facelift Specialist, Dr. John Burns

Before and after facelift by Dallas Facelift Specialist, Dr. John Burns
Before and after facelift by Dallas Facelift Specialist, Dr. John Burns
Before and after facelift by Dallas Facelift Specialist, Dr. John Burns
Before and after facelift by Dallas Facelift Specialist, Dr. John Burns

Lean Towards Experience When Making Your Choice

A facelift is a life-changing procedure that should be beautiful in design and result. When considering facial plastic surgery, it's best to consider a skilled plastic surgeon who is:board-certified has extensive experience (proven by before and after photos and patient reviews) with facial plastic surgeryunderstands your facial intricacies, concerns, and how to rejuvenate your appearance that produces a natural result, not a bad facelift.

Going to a less experienced or cheaper surgeon may lead to a devastating outcome. Be very selective in your choice of facelift surgeon so that you get your dream result, a more youthful appearance, and so that you avoid unfortunate outcomes.

Turn That Frown Upside Down With A Revision Facelift

If you've had a bad facelift, please don't lose hope. There is always a solution to your unforeseen or undesired outcome. A board-certified plastic surgeon experienced in facelift revision will get you there. Dr. Burns offers complimentary facelift consultations to help you create a plan that is sure to make your love your look.

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