Revision Facelift

Dr Scott J Turner is a Specialist Plastic Surgeon (FRACS) practising in Sydney with over a decade of experience specialising in facial aesthetic surgery. At his Sydney clinic, Dr Turner performs revision facelift procedures for patients experiencing unsatisfactory outcomes from previous facial surgery or seeking correction of complications that developed following their initial facelift.

Revision facelift surgery, also known as secondary facelift, addresses concerns arising from prior facial procedures. These concerns may include technical deficiencies from the original surgery, anatomical distortions that developed during healing, progressive changes that occurred post-operatively, or results that failed to meet patient expectations despite appropriate healing. Revision procedures require advanced surgical expertise due to altered tissue planes, scar tissue formation, and modified anatomical relationships resulting from previous surgical intervention.

Understanding Revision Facelift Surgery

Revision facelift surgery encompasses a broad spectrum of corrective procedures designed to address specific issues arising from previous facial surgery. Unlike primary facelift procedures performed on unaltered anatomy, revision surgery requires navigating through previously operated tissues, where surgical planes have been disrupted, scar tissue has formed, and the vascular supply may be compromised.

Common Indications Requiring Revision Surgery

Patients seek revision facelift consultation for various reasons, ranging from technical surgical complications to natural progression of ageing beyond the initial correction. Understanding these indications helps determine whether revision surgery represents an appropriate solution.

Technical Complications from Prior Surgery:

Specific anatomical distortions can develop as direct consequences of the surgical technique employed during the initial procedure. These include:

Pixie Ear Deformity: The earlobe becomes tethered to the facial skin, resulting in a stretched appearance and a lack of the natural, detached contour. This distortion typically results from excessive tension placed on the skin during closure, particularly when insufficient attention is directed toward SMAS layer repositioning. The earlobe pulls downward and forward, creating an unnatural attachment that remains visible when viewed from any angle.

Hairline Displacement: Temporal or posterior hairline positions shift from their original locations, creating visible hair-bearing skin in unnatural positions or baldness in regions previously covered by hair. This complication frequently occurs when incisions are poorly positioned or when excessive skin tension pulls hair-bearing scalp tissue forward or downward during the healing process.

Lateral Sweep Deformity: Visible parallel bands or lines extend from the lateral cheek toward the ear, creating an artificial appearance. This occurs when skin receives disproportionate tension without adequate deeper structural support from properly repositioned SMAS and platysma layers. The deformity becomes particularly evident during facial animation.

Visible or Widened Scars: Incision lines remain conspicuous rather than fading to barely perceptible traces. Poor scarring develops from various factors, including excessive tension during closure, improper incision placement, wound infection, inadequate wound care, or individual healing characteristics, including a tendency toward hypertrophic or keloid scar formation.

Cobblestoning or Skin Irregularities: The skin surface appears uneven with visible depressions, elevations, or textural irregularities. These typically result from inadequate fat removal, uneven SMAS manipulation, or aggressive liposuction techniques that damage the subdermal plexus.

Contour Asymmetry: One facial side appears noticeably different from the opposite side regarding tissue position, skin tightness, or overall contour. While subtle asymmetry exists in all faces naturally, significant post-operative asymmetry suggests technical inconsistency during the original procedure.

Inadequate Neck Correction:

The neck region frequently requires revision when the initial procedure failed to adequately address underlying anatomical structures. Common neck issues include:

• Persistent platysmal banding is visible when muscles contract
• Residual submental fullness from inadequate fat removal
• Inadequate skin tightening, leaving visible laxity
• Over-resected submandibular glands create excessive hollowing
• Irregular contours from uneven liposuction

Excessive Tissue Tightness:

Overcorrection during the initial surgery creates an unnatural appearance, where the facial skin appears stretched, expressions seem restricted, and the overall aesthetic lacks the appropriate softness. This “windswept” or “operated” appearance results from excessive skin tension without adequate deeper-layer support. Patients often describe feeling their face is “too tight” or expressing concerns that they “don’t look like themselves.”

Nerve Complications:

Injury to facial nerve branches during the initial surgery may cause temporary or permanent functional deficits. The frontal branch, which supplies forehead and brow movement, and the marginal mandibular branch, which controls lower lip depression, are particularly vulnerable. Symptoms range from subtle weakness to complete paralysis of affected muscles. While many nerve injuries recover spontaneously over months, permanent deficits occasionally occur, requiring revision surgery to improve facial symmetry or restore function when possible.

Progressive Ageing Changes:

Even technically successful facelift procedures eventually succumb to continued ageing. Tissues that were effectively repositioned gradually descend again over the years as the ageing process continues. Most well-performed facelifts provide meaningful improvement for 8-12 years before revision becomes appropriate. Factors that accelerate recurrent tissue descent include substantial weight fluctuations, smoking, inadequate sun protection, and inherent tissue quality.

Insufficient Initial Correction:

Some patients experience disappointing outcomes not from technical complications but from conservative surgical planning that failed to address the degree of tissue laxity present. When the initial procedure employed limited techniques—such as skin-only tightening without SMAS manipulation—results proved disappointingly short-lived and inadequate.

Why Revision Surgery Proves More Complex

Revision facelift surgery presents substantial technical challenges compared to primary procedures. Understanding these complexities helps patients appreciate why selecting an experienced facial plastic surgeon remains paramount.

Altered Surgical Anatomy: Previous surgery disrupts normal anatomical planes and tissue relationships. Structures that should separate easily during dissection instead adhere through scar tissue. This makes tissue elevation more difficult, increases the risk of bleeding, and complicates the identification of critical structures, such as facial nerve branches.

Compromised Blood Supply: Initial surgery disrupts some vascular channels supplying facial tissues. While collateral circulation typically provides adequate blood flow, revision surgery further compromises the remaining vessels, increasing the risk of skin necrosis. This necessitates conservative tissue handling and sometimes staged procedures to ensure tissue viability.

Reduced Tissue Mobility: Scar tissue formation restricts tissue movement, limiting the degree of correction that can be achieved during revision. Skin that stretched easily during the primary procedure now demonstrates reduced elasticity, requiring different surgical approaches to achieve meaningful improvement.

Limited Remaining Tissue: Previous skin excision reduces the amount of tissue available for repositioning during revision. This becomes particularly limiting when multiple revisions have been performed or when excessive skin was removed initially.

Psychological Considerations: Patients seeking revision surgery often carry an emotional burden from disappointing previous results. Managing expectations becomes crucial, as revision surgery may improve but cannot always entirely correct all concerns, particularly when anatomical limitations exist.

Revision Surgery Versus Additional Facial Procedures

Distinguishing revision facelift from new procedures performed after a previous facelift proves important. Revision surgery specifically corrects problems from the initial operation—addressing distortions, asymmetries, or complications. Additional procedures performed after a successful primary facelift to address new ageing changes or different anatomical concerns represent secondary surgery rather than proper revision.

For example, undergoing blepharoplasty ten years after a facelift represents additional surgery rather than revision. However, correcting earlobe distortion or persistent jowling that the initial facelift failed to adequately address represents true revision surgery.

Am I a Suitable Candidate for Revision Facelift Surgery?

Revision facelift surgery is suitable for carefully selected individuals who have experienced specific issues following previous facial surgery. Appropriate candidate selection remains crucial for achieving improvement whilst maintaining realistic expectations about correction possibilities given altered anatomy from prior surgery.

Physical and Health Prerequisites

Suitable revision facelift candidates demonstrate:

• Good general health without conditions compromising surgical safety or healing capacity
• Stable weight maintained for at least six months before surgery
• Non-smoking status or complete willingness to cease all tobacco and nicotine products for a minimum of eight weeks before and after surgery (longer than primary facelift requirements due to increased tissue compromise)
• Adequate tissue quality capable of tolerating additional surgical manipulation
• Realistic understanding that revision surgery improves but may not completely correct all concerns
• Psychological readiness for additional surgery (mandatory psychological assessment required per Australian regulations effective July 1, 2023)

Appropriate Timing for Revision Consideration

Timing is critical for the success of revision surgery. Adequate healing from the initial procedure must occur before revision can be safely performed:

Minimum Waiting Period: Most surgeons recommend waiting at least twelve months following a primary facelift before considering revision. This allows for complete tissue healing, scar maturation, final result manifestation, and resolution of swelling. Premature revision compromises tissue viability and increases the risk of complications.

Earlier Intervention Exceptions: Certain complications warrant earlier revision, including:

• Haematoma requiring evacuation
• Wound dehiscence (separation) requiring closure
• Infection necessitating surgical intervention
• Severe asymmetry from a technical error was evident immediately post-operatively

Extended Waiting Periods: For patients who have undergone multiple previous surgeries or have demonstrated poor healing from the initial procedure, waiting eighteen months or longer may be advisable before attempting revision.

Specific Concerns Amenable to Revision

Revision facelift effectively addresses various concerns, though the degree of correction varies depending on tissue quality and previous surgical impact:

Anatomical Distortions: Issues like pixie ear deformity, hairline displacement, or lateral sweep typically respond well to revision techniques specifically designed to correct these problems.

Inadequate Correction: When the initial surgery employed insufficient techniques or conservative tissue manipulation, revision using more comprehensive approaches—such as deep plane dissection—often achieves meaningful improvement.

Asymmetry: Facial asymmetry from uneven tissue repositioning or healing can typically be improved through selective augmentation or additional lifting of the less corrected side.

Poor Scarring: Unfavourable scars can be revised through scar excision, re-closure with refined technique, or scar repositioning to less visible locations. However, patients prone to hypertrophic or keloid scarring may experience recurrent poor scar formation despite optimal technique.

Neck Contour Issues: Persistent platysmal banding, inadequate fat removal, or insufficient skin tightening can be corrected through a revision neck lift that incorporates appropriate techniques not employed in the initial surgery.

Recurrent Ageing Changes: When tissues have relaxed again years after a successful primary facelift, revision surgery can restore the initial improvement. However, it typically provides shorter-lasting results than the original procedure due to cumulative tissue manipulation.

Patients Who May Not Benefit from Revision

Revision surgery may prove inappropriate or provide limited benefit for specific individuals:

• Patients with unrealistic expectations about achievable correction, given anatomical limitations from previous surgery
• Those unable to accept that revision may improve, but not entirely correct all concerns
• Individuals with poor tissue quality are unlikely to tolerate additional surgical trauma
• Patients who continue to use tobacco, or are unwilling to completely cease smoking
• Those with medical conditions that substantially increase the surgical risk
• Individuals experiencing body dysmorphic disorder, where surgical intervention proves psychologically contraindicated

The Importance of Surgeon Selection for Revision Surgery

Choosing an appropriately qualified surgeon for revision facelift proves even more critical than for primary procedures. Revision surgery demands:

• Extensive facial surgery experience, particularly with complex cases
• Deep understanding of three-dimensional facial anatomy and surgical plane relationships
• Technical expertise in working through previously operated tissues
• Ability to identify and protect facial nerve branches in distorted anatomy
• Experience managing compromised tissue vascularity
• Honest communication about realistic outcomes and limitations

Dr Turner’s decade of experience, specialising exclusively in facial aesthetic surgery, provides the expertise essential for addressing complex revision cases while managing patient expectations appropriately.

Recovery and Aftercare After Revision Facelift Surgery

Recovery following revision facelift surgery typically proves somewhat more prolonged and uncomfortable compared to primary procedures due to increased tissue trauma from working through scar tissue. Following your revision, you’ll remain in hospital overnight before being discharged the next day with comprehensive post-operative care instructions.

The first two to three weeks involve managing swelling and bruising, which typically exceed those associated with primary facelift surgery due to the greater tissue disruption. Swelling peaks around days three to four before gradually improving. During this critical early phase, continuous head elevation above heart level, restricted facial movements, soft food diet, and complete avoidance of straining activities remain mandatory. Discomfort during the first week proves manageable with prescribed medications, though patients generally require analgesia for a longer duration than primary surgery recovery.

Sutures are removed progressively between days seven and fourteen. Temporary numbness around surgical sites is expected and typically persists longer than the primary surgery, sometimes requiring several months for complete sensory return. By weeks three to four, most patients can resume light non-strenuous work, though visible post-operative changes remain evident during this period. Strenuous exercise, heavy lifting, and high-impact activities should be avoided for at least eight weeks.

Your revision results become increasingly apparent between three to six months as residual swelling completely resolves, tissues settle into their new positions, and incision lines mature. Some patients require minor touch-up procedures to refine contours or address small asymmetries—this represents normal revision surgery practice rather than a complication.

For detailed information about each recovery milestone, including specific care instructions and strategies to optimise healing, please visit our comprehensive resource:

Recovery After Facelift Surgery

Risks and Complications of Revision Facelift Surgery

Revision facelift surgery carries elevated risks compared to primary procedures due to altered anatomy, scar tissue formation, and compromised tissue blood supply from previous surgery. Understanding these risks is essential for making informed decisions about whether revision surgery is an appropriate solution to address your concerns.

Most patients experience expected post-operative effects, including swelling, bruising, temporary numbness, and discomfort that gradually resolve during healing. However, complications from revision surgery occur more frequently than those from primary procedures. Potential complications include haematoma formation (blood collection requiring drainage), infection, unfavourable scarring despite optimal technique, prolonged altered sensation that may be permanent, contour irregularities, and persistent asymmetry despite corrective efforts.

More serious but less common risks prove particularly relevant to revision surgery: skin necrosis (tissue death) from compromised blood supply occurs more frequently in revision cases, especially in patients who smoke. Facial nerve injury causing temporary or permanent movement impairment or sensory changes represents an increased risk when dissecting through scar tissue, where nerves may be displaced or encased in fibrous tissue. Significant asymmetry persisting despite revision attempts occasionally occurs when tissue quality limits the achievable correction. Disappointment with results remains possible when anatomical constraints from previous surgery prevent the complete correction of all concerns.

Dr Turner employs meticulous surgical technique, specifically adapted for revision cases. This includes comprehensive preoperative assessment, including vascular evaluation when indicated, and surgery exclusively in accredited facilities with experienced anaesthetic support. Additionally, detailed postoperative care protocols are implemented to minimise complications while optimising outcomes within anatomical limitations.

For comprehensive information about specific risks, preventive measures, and realistic outcome expectations, please visit our detailed guide:

Risks and Complications After Facelift Surgery