What it means for a patient
- A second facelift usually comes about a decade after the first.
- The surgery is harder because of scar tissue and a thinner SMAS layer, but complication rates in published studies were similar to first facelifts.
- Hematoma and temporary facial nerve weakness are the most common problems to discuss before surgery.
- Limits: 14 studies of mixed design, with a wide range of complication rates.
Why this paper matters
It gathers the published data on secondary facelifts, names the anatomical changes surgeons face, and gives a range of complication rates. It supports the view that a second facelift is more complex but not clearly riskier.
Overview
Demand for secondary facelifts is rising, and they are harder than first facelifts because earlier surgery changes the anatomy. The authors searched PubMed and Scopus for trials, observational and comparative studies, case series and case reports on secondary rhytidectomy outcomes. They set out the challenges, common surgical principles, results and complications.
Findings
- 14 articles; 737 patients.
- Patients presented about 9-12 years after the first facelift.
- The most consistent finding during surgery was altered anatomy: a thinner, more delicate SMAS, fibrosis and scarred tissue planes.
- Complication rates in cohort studies ranged from 2.0% to 21.1%.
- The most common complications were hematoma and temporary facial nerve injury.
- Temporary facial nerve injury reached 11.9% in some series.
- Other events: seroma, minor skin slough and delayed healing.
- Overall complication rates appear comparable to those of primary facelifts.
Terms
- Secondary rhytidectomy: a repeat facelift after an earlier one.
- Primary facelift: a person's first facelift.
- SMAS: the superficial musculoaponeurotic system, a fibrous and muscle layer under the facial fat.
- Fibrosis: thickened scar-like tissue.
- Tissue planes: the natural layers between tissues that surgeons separate.
- Skin slough: loss of a thin area of surface skin.
- Hematoma: a collection of blood under the skin after surgery.
- Systematic review: a study that searches for and combines published research on one question using set rules.