Can I Get a Second Facelift?

Mature Woman Happy with Her Second Facelift Procedure

Even the best facelift (rhytidectomy) results naturally fade over time, but you can take steps to maintain your rejuvenated appearance as you continue to age. If it’s been 10 or more years since your initial facelift—or if contributing factors such as illness, weight loss, or sun damage have diminished your results—you may benefit from a secondary facelift. In this post, board certified cosmetic surgeon Dr. Sobel discusses the procedure and whether or not a secondary facelift may be right for you.

What is a secondary facelift?

A secondary facelift is performed after an initial facelift to refresh your facelift results. It is typically desired and planned years after the initial procedure, often a decade or more later. It is different from a revision facelift, which is performed to correct undesirable facelift results.

You can have a secondary facelift with your original surgeon or a different cosmetic surgeon, if you prefer; what is most important is that your surgeon has specific expertise in secondary facelifts.

Whatever amount of time has passed since your first facelift, expect your secondary facelift consultation process to be a bit different. Your cosmetic surgeon will examine your face more closely for evidence of your past procedure before recommending a procedure plan. Also expect your surgeon to recommend complementary procedures to counteract aging-related skin volume loss, since your skin will have changed since your initial procedure, and improving texture and plumpness is important to achieving attractive results.

How is a secondary facelift performed?

When planning a secondary facelift, it is very important to consider the technique used for your initial facelift. One primary reason is that we can often reuse past incision sites to reduce scarring. That said, if your previous surgeon had poor incision technique, I may choose to plan new incisions (hidden in the hairline) to ensure optimal results and healing.

Combining procedures for better results

A key difference with a secondary facelift is the importance of added procedures to complete your renewal. This is because addressing volume loss is not possible with surgical rhytidectomy alone—simply re-tightening the skin will create an “overdone” appearance that is not at all desirable. To create a natural, rejuvenated look, I replace volume by injecting a patient’s own fat (fat transfer), using dermal fillers, and/or placing facial implants. Alternatively, if a patient has adequate facial volume, I may be able to perform a deep plane facelift by lifting the muscle layer beneath the skin.

As you can see, there are some important differences when designing a treatment plan for a secondary facelift; however, your experience is likely to be very similar to your initial facelift. You will still undergo general anesthesia and experience a similar overall recovery.

How will I know if I need a secondary facelift?

As a board certified cosmetic surgeon, my facelift patients often ask me how they will know when they need a secondary facelift. Here are some factors I look for in a secondary facelift candidate.

Sagging and volume loss

As we age, our face naturally loses volume, making it appear slack or saggy. Age-induced volume loss can be exacerbated by illness, medications, and weight loss. The 3 most common types of volume loss I see in patients are:

  • Bone loss. By the time we’re 40, most people begin to lose bone density. By age 50, bone breakdown outpaces bone formation in most adults.
  • Fat atrophy. By the age of 35, most people lose about 10% of their facial fat and continue to lose an additional 5-10% every 5-10 years after.
  • Skin atrophy. We all lose thickness in our skin at different rates due to environmental, genetic, and lifestyle factors; however, most people begin to experience thinner, more fragile skin in their 40s that naturally worsens with age.

All of this combined volume loss can cause severe wrinkling and sagging by the time we reach our 60s, even among the healthiest people. Here are a few examples of how I see volume loss affect the face over time:

  • The temples begin to hollow and the brow fat pad shrinks, causing the eyebrows to sag.
  • As the cheekbones shrink and cheek fat diminishes, the mid-face starts to droop, causing the nasolabial folds to look more prominent.
  • The upper and lower jawbones regress and the lips lose collagen, leading to the appearance of jowls & droopy lips, and the loss of jawline definition.

Photoaging

Photoaging, or the aging effect on skin caused by exposure to sunlight, causes disorganization of collagen fibers and loss of elasticity within the skin. Every year, photoaging decreases the amount of collagen present in skin, making it consistently thinner, duller, and more fragile. Other types of sun-induced skin damage include:

  • Pigmentary irregularities
  • Broken capillaries
  • Skin lesions
  • Skin texture irregularities
  • Melasma

Why you may not need a secondary facelift

Though secondary facelifts can be undertaken in a safe manner and provide excellent results, they are often unnecessary to help patients attain their rejuvenation goals. Many patients who seek a secondary facelift are surprised to learn that their primary facelift is still effectively supporting the skin and soft tissues of their face. These are typically patients who had a quality facelift performed initially, and who have aged naturally without any major physical or lifestyle changes. For these patients, I often suggest the following non-surgical treatments:

  • For patients who have mild to moderate volume loss in the face, simple dermal filler injections can temporarily restore contour to the face and support sagging skin, as well as fill in deep wrinkles and folds. Fillers also stimulate collagen production in your skin for younger, smoother skin that improves for months after it’s treated.
  • Botox injections can help temporarily release dynamic wrinkles and lines, such as those in the forehead, around the eyes, and at the corners of the mouth. For patients who have experienced mild to moderate skin aging since their initial facelift, Botox injections can take years off their appearance without the need for further surgery.
  • Thermage Skin Tightening is often referred to as the “lunchtime facelift” because it tightens lax skin on the face and body without surgery, making it a great option for patients who don’t require a full facelift or want to avoid excessive downtime. By using radiofrequency energy, the Thermage device heats deep layers of your skin to prompt collagen production, resulting in firmer, younger-looking skin that keeps improving over the next 6 months.

Can a secondary facelift correct fine lines and wrinkles?

It’s a common misconception that a facelift will correct the appearance of fine lines and wrinkles. Facelifts are great at restoring shape and symmetry to the face and neck, and they will initially improve fine lines and wrinkles dramatically; however, after the initial swelling subsides, a good facelift will gradually relax (slightly) so that the results appear natural. Any procedure that pulls the skin so tight that all the wrinkles are no longer visible will lead to an overdone look.

Thankfully, there are many non-surgical treatments that can be combined with a facelift to improve fine lines and wrinkles, such as dermal fillers, Botox, and Thermage.

How difficult is it to perform a secondary facelift?

There are a number of factors that influence the difficulty of performing a secondary facelift. The secondary facelift process may actually be eased by the fact that the blood supply to skin that has been previously “lifted” during a primary facelift is stronger. Additionally, because the field of cosmetic surgery is constantly evolving, new facelift techniques may allow a skilled surgeon to perform surgery more efficiently with less swelling and downtime than your initial facelift.

When planning a secondary facelift, it is very important to consider the technique used for your initial facelift.

However, performing surgery on any part of the face that has previously been operated on can be challenging due to scarring and prior changes to the SMAS layer (the physiological system that divides the deep and superficial facial tissues). After an initial facelift, your connective tissues are typically thinner (I often see thinning skin behind the ears from where initial facelift scars were placed), and therefore your surgeon must be extremely careful and meticulous when making incisions to avoid damaging your deep tissues. Incisions must be carefully planned to preserve a patient’s hairline, and if possible, to improve upon any previous scars.

Is a secondary facelift safe?

A secondary facelift is safe for most patients; however, there are some specific factors to consider, such as your skin quality, health, and any lifestyle changes you may have made since your first facelift. Smokers and people with blood disorders are not good candidates for a secondary facelift. If you’re curious if you are a good candidate for a secondary facelift, I’d be happy to meet with you during a private consultation.

Schedule your secondary facelift consultation with Seattle’s Dr. Sobel

Board certified cosmetic surgeon Dr. Alexander Sobel has been helping his patients age gracefully with facelift surgery in the Seattle/Bellevue area for over 14 years. Dr. Sobel had the honor of being voted as a Seattle-area Top Doctor in the Seattle Met’s 2018 Top Doctor awards. To find out if you could benefit from a secondary facelift, contact Anderson Sobel Cosmetic Surgery online or call (425) 453-9060.

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