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A revision facelift is a second facelift performed to correct the result of an earlier one. People seek it for different reasons: the lift relaxed within a year or two, the face looks tight or swept sideways, the scars are visible, the hairline has shifted, or the earlobes have been pulled down. Sometimes the first operation was fine and simply ten or fifteen years have passed. That last situation is usually called a secondary facelift, and it is more straightforward than correcting a problem.
Revision surgery is different from a first facelift in one important way. The anatomy has already been changed. There is scar tissue under the skin, some skin has already been removed, and the deeper layers may have been tightened, trimmed or left untouched. Understanding what was done before is the starting point for deciding what can be done now.
Common reasons for a revision
Early recurrence of sagging. When a lift relies mainly on the skin, or the deeper layer is not repositioned securely, the jowls and neck can return within a year or two. The usual correction is a more structural lift, often a deep plane facelift, which moves the tissue as one unit and does not depend on skin tension.
A pulled or windswept look. This happens when the lift is directed sideways towards the ear rather than upwards, or when too much tension is carried by the skin. The mouth corners can look stretched and the cheeks flattened. Revision changes the direction of pull, releases the tight skin and often restores volume with facial fat transfer.
Scar and hairline problems. Scars that have widened, stepped or become visible in front of the ear, and a temple hairline that has moved upwards or backwards, are among the most common complaints. Scars can be revised, and incisions can be redesigned to preserve or restore the sideburn.
Earlobe and tragus distortion. A “pixie ear”, where the lobe is pulled down and stuck to the cheek, and a tragus (the small cartilage in front of the ear canal) that has been pulled forward, are both signs of tension in the wrong place. Both are correctable.
An untreated neck. Some first operations lift the face but leave the neck behind. A neck lift can be added to bring the two back into balance.
What can realistically be improved
| Problem after the first facelift | Usual approach | How much it can improve |
|---|---|---|
| Jowls and neck laxity returned | Deeper, more structural lift | Usually very well |
| Pulled, flattened or windswept look | Change the lift direction, release skin, add volume | Often well; limited if much skin was removed |
| Wide or stepped scars | Scar revision, tension-free closure | Usually well |
| Temple hairline or sideburn lost | Redesigned incision, sometimes hair grafting | Partly |
| Earlobe pulled onto the cheek | Lobe release and reconstruction | Usually well |
| Hollow cheeks or temples | Fat transfer | Well, may need a second session |
A secondary facelift after many years
Not every second facelift is a correction. Many patients had a good result fifteen years ago and are simply older now. The jawline has softened again, the neck has loosened and some volume has been lost. This is sometimes called a secondary rather than a revision facelift. The principles are the same, but there is usually no problem to undo, only natural ageing to treat. Because some skin was removed the first time, and the deep layer may already have been lifted, the operation is planned around what remains. Results in this group are often very satisfying.
Why waiting matters
It is tempting to want an unsatisfactory result fixed quickly. In most cases, though, waiting at least twelve months after the first operation leads to a better outcome. In the first months the tissues are still swollen and stiff, scars are immature and some early problems improve by themselves. Operating through fresh scar tissue is also more difficult. The exception is a genuine complication, such as a wound problem or a collection of blood or fluid, which should be treated promptly.
The consultation
A revision consultation takes longer than a first one. Dr. Mehmet Özdemir will want to know:
- when the first operation was done, where and by what technique, if known
- what you liked about the result and what bothers you now
- whether there were complications during healing
- your general health, smoking history and any weight change since
He will examine the skin quality, the scars, the position of the hairline and ears, the movement of the face and the firmness of the tissues underneath. Photographs from before your first facelift are very useful, because they show what your face looked like before anything was changed.
The honest answer to some requests is that a problem can be improved but not completely erased. If a lot of skin was removed the first time, for example, there is less room to change direction or tension. You should leave the consultation with a clear idea of what is realistic.
What the operation involves
Most revision facelifts are performed under general anaesthesia and take four to six hours. Existing scars are usually used as the incisions, and are redesigned where needed to improve their position. The surgeon dissects carefully through the scar tissue, identifies the deeper layer and repositions it in a more vertical direction. Where the first operation caused volume loss or a hollow look, fat can be transferred to the cheeks, temples or jawline at the same time.
Skin is removed only if there is genuine excess, and the closure is made without tension. That is the single most important principle in correcting a pulled face or a distorted earlobe.
Recovery
Recovery after a revision is similar to a first facelift, although swelling can last a little longer because of the scar tissue. You stay two nights in hospital. Stitches are removed between days seven and ten. Most patients are comfortable returning to work and social life after about three weeks. Firmness and numbness can take several months to settle fully, and the final result is judged at nine to twelve months.
Risks
Secondary surgery carries the usual facelift risks, including bleeding, infection, delayed healing, numbness, nerve weakness and asymmetry. The chance of wound healing problems is higher when the skin has been operated on before, particularly in smokers, so stopping all nicotine is essential. The surgery is planned to protect the blood supply to the skin. A hemostatic net may be used to reduce the risk of a haematoma.
Planning revision surgery in Istanbul
International patients should allow around ten days in Istanbul. This leaves time for the examination, the operation, the two nights in hospital and follow-up visits until the stitches are removed. If you are sending photographs in advance, include clear pictures from the front, both sides and both three-quarter views, taken without make-up and with your hair tied back so the scars and hairline can be seen.
Dr. Mehmet Özdemir is a plastic, reconstructive and aesthetic surgeon holding the EBOPRAS qualification, with training in Germany, Poland and Brazil. He consults in Turkish, Kurdish, English and German and practises in Bakırköy, Istanbul.
