​​A facelift is perhaps the most delicate procedure in all of plastic surgery. Because your face is the focal point of your person, the results are constantly on display. While there can be complications such as scar tissue, nerve damage, or an unnatural appearance, some people require a revision for personal reasons like unsatisfactory results.

If your previous surgery didn’t meet your expectations please don’t lose hope. Revision facelift surgery is always possible.

How Common Is Facelift Revision Surgery?

Unfortunately, revision facelift surgery is more common than you might think. Reasons for getting a revision for a previous facelift can vary widely and include some of the following concerns:

• poor scarring
• asymmetry
• unnatural physical features like a pixie ear deformity
• early recurrence of tissue laxity
• poor neck contour

For minor “tweaks,” a revision might be accomplished in the office using local anesthesia. More complex revisions will require a secondary procedure in the operating room. Regardless, don’t be afraid to discuss your dissatisfaction with your plastic surgeon.

Frustration 1: The Initial Results Aren't Stellar

Expectations vary widely and are often unreasonable; even in the most skilled hands. When evaluating your result you’ll first need to wait until all the bruising and swelling have completely subsided. This generally takes about 2 – 3 months. Some surgeons advocate waiting at least 6 months before making any final determination.That said, it's important to discuss possible outcomes of your facial surgery, including what you do and don't like about your initial outcome.

Review Your Results Together

When evaluating your results, rely on STANDARDIZED before and after photos that strictly follow the American Society of Plastic Surgeons guidelines. You will look much different in photographs than in the mirror. In addition, the standardized photos will show exactly what you look like without animation, shadowing, or manipulation.

It is important to review the photos with your surgeon and clearly communicate what you would like revised based on the photos. Your surgeon should be able to give you an honest and critical evaluation to decide if a revision would move you closer to your goals.

If your results aren’t stellar you might focus on your before photos and look at areas of improvement. Some common concerns are asymmetry, undercorrected laxity, neck banding, ear and hairline positioning, scarring, and overall contour. Discuss these with your surgeon based on the before and after photos.

Frustration 2: You've Got Uneven Results

Symmetry is critical in facial balance while understanding that no face is symmetric. If your asymmetry was significant before, it's likely that it was impossible to completely correct. Much like the left and right sides of your face are not identical, neither are your eyes or brow position. One eye will always be more oval-shaped with a more open appearance. This is normal.

Asymmetry can be a real issue after a facelift if one side is pulled tighter or there is a complication on one side such as a hematoma or wound healing issues. Asymmetry can also present in brow position or neck contour. Uneven results should be able to be corrected in most situations.

Frustration 3:  You Had A Complication

Scarring

Facelifts cannot be done without making incisions resulting in scars. Facelift incisions are carefully designed to be as hidden as possible carefully tracing the anterior hairline, ear creases, earlobe, and behind the ear. The incision at the neck is carefully placed just under the chin. These scars are virtually imperceptible in the best of circumstances, but for some, they can become unsightly.

• Once healed from breast augmentation surgery, it's best to always support your implants with a form-fitting bra, especially when exercising. Good external support will help more than anything in preventing sagging and stretching of the tissue.
• Finally, nurture your breast skin with daily application of a hydrating moisturizer and sunscreen at the decolletage.

Too Tight

The most common cause of poor scarring is uneven or excessive tension on the incision. A properly done facelift should rely on support from the deep plane or SMAS layer where most of the correction needs to be done. The skin should redrape naturally and without tension so that the skin edges touch. If excessive or uneven tension is placed on the incisions either by a poor design, too much skin removed, or relying simply on the skin to pull then the scars will widen and pull away from the hairline or ears. When this happens the scars will be visible and widen.

Poor Blood Supply

A less common cause is poor wound healing where the blood supply to the skin edges is compromised and the wound forms a scar that has to heal by secondary intention. If the facelift develops a wound the scars are typically very side and visible. These types should be fully mature before attempting scars in a revision procedure.

Pixie Ears

The pixie ear refers to a complication of a facelift where the earlobe grows into the facial skin and is pulled downward and forward resembling a pixie. This is a result of poor technique when insetting the earlobes. When redraping the facial skin, extreme care should be given to the area around the earlobes. It is critical to avoid undue tension in this area and even sew the skin just under the earlobe so that it is slightly detached. Conversate about your earlobes with your surgeon before your revision surgery to understand whether you have attached or unattached earlobes.

Hairline

Poor facelift technique can alter the hairline and in the worst cases cause unnatural bald spots. The most reliable incision traces the anterior hairline around the temple to avoid elevating the sideburn and temple hair. Extending the incision straight into the hairline can result in the removal of the sideburn and temple hair resulting in an unsightly bald spot. This is almost impossible to correct without a hair transplant. Behind the ear, the skin removal should not alter the posterior hairline. Often, surgeons will leave a stairstep at the posterior hairline if the hairline is not perfectly realigned.

Particular attention should be made for male patients who also have a beard to contend with and shorter hair to hide the incision. Male patients should be convinced that their incision might be more visible due to the beard, short hair, or male pattern baldness. Different techniques are utilized in male patients and patients should make sure the surgeon is facile in male facelift surgery.

Poor facelift technique can alter the hairline and in the worst cases cause unnatural bald spots. The most reliable incision traces the anterior hairline around the temple to avoid elevating the sideburn and temple hair. Extending the incision straight into the hairline can result in the removal of the sideburn and temple hair resulting in an unsightly bald spot. This is almost impossible to correct without a hair transplant. Behind the ear, the skin removal should not alter the posterior hairline. Often, surgeons will leave a stairstep at the posterior hairline if the hairline is not perfectly realigned.

Particular attention should be made for male patients who also have a beard to contend with and shorter hair to hide the incision. Male patients should be convinced that their incision might be more visible due to the beard, short hair, or male pattern baldness. Different techniques are utilized in male patients and patients should make sure the surgeon is facile in male facelift surgery.

Neck Contour

The neck is one of the most common reasons women and men seek out facial rejuvenation. Neck contour is one of the first places to age and is often bothersome to patients before jowling and descent of facial soft tissue. Neck contour depends on fat, excess skin, and neck muscle (platysmal) laxity. All three components should be addressed for optimal contour.

The lack of a sharp next contour is one of the most common complaints following facelift surgery. This might be due to excess fat, excess or loose skin, or recurrent platysma banding. Before a revision is done, the cause should be identified and correction focused on that cause: fat, skin, or muscle.

Learn more here: 4 Telltale Signs of A Bad Facelift

Frustation 4: Your Results Aren't Lasting

All patients are different and unique, so there is no one-size-fits-all for facelifts. That said, it's reasonable to expect your facelift to last at least 10 years. Plastic surgery does not stop the aging process. One way to look at a facelift is to think of a timeline. After surgery, one can expect to look 10 – 15 years younger. It would then take about 10 years for you to age back to your starting point meaning that the overall improvement is about 20 years. Most patients will have their initial facelift in their early to mid-50s and do another facelift around age 70.

If you were initially pleased with your facelift but now notice that your results are not lasting, you should contact your plastic surgeon. Facelifts need maintenance to look their best. Sunscreen, a good diet, hydration, not smoking, and using skin care is essential. Adding Botox and/or fillers helps tremendously with dynamic aging and filling to maintain facial volume. Many patients will do something like a chemical peel, photo facial (broadband light), or laser to keep the collagen in their skin fresh and remove superficial skin damage.

In most cases when your primary surgery is not long-lasting, the deep plane was not properly addressed and too much of the correction was applied to the skin which easily stretches with time and gravity. The SMAS or deep plane will hold up much better and last much longer.

Another cause would be poor skin quality due to the patient's genetic predisposition. Many patients have skin without much elastin and collagen and their tissues will easily stretch over time. These cases require even more maintenance and often several redos to keep the tissue tight.

Frustation 5: You've Lost or Gained Weight

Weight gain and loss can have a profound effect on facial tissue. Weight gain causes a round face that lacks contour. The heavier face will look aged due to both gravity and distortion of anatomic structures. When patients lose weight there is a deflational effect where loss of volume leads to underfilled, loose skin. The more rapid the weight loss the more the tissue will hang. We see this a lot with the recent advent of the weight loss drug semiglutide which leads to rapid weight loss in most patients and is commonly known as “Ozempic face.”

Experience matters when it comes to a facelift. Different surgeons have different styles and techniques. At a minimum, ensure your surgeon is certified by the American Board of Plastic Surgeons and has many years of experience performing facelift surgery. Spend time looking at their before and after photos where the “before” photos look similar to yours. Ask for recommendations from that surgeon’s practice. Ensure your procedure is done in a fully accredited facility and that you will also have a board-certified anesthesiologist to do your anesthesia. Inquire about the follow-up process and make sure you will have the opportunity to discuss your results with your surgeon.