Some facelift patients return years later because the face kept aging after surgery. Others return because something about the first result needs correction or refinement. Both fall under one heading, the revision facelift, and both start from a face that has already had surgery.
Leo Lapuerta, MD, FACS, a triple board-certified plastic surgeon in the Houston area, lists revision facelift among the types of facelift surgery his practice performs. His practice describes it briefly: a revision corrects, refines or renews a lift for a patient who has had facelift surgery before, and the work requires careful assessment of scar tissue, remaining skin, prior technique and current goals.
Two reasons to operate again
The first reason is time. A facelift does not stop the aging process, and the practice states that patients continue to age afterward. The life of a result depends on skin elasticity, skin quality, weight stability, sun exposure and the technique used, and no fixed number applies to every patient. A patient who had a good result years ago may want renewed lifting as those factors play out.
The second reason is the first operation itself. A patient may want a result corrected or refined. The practice does not catalog the problems that lead to revision, and the specifics vary from face to face, which is why the assessment matters so much.
Four things the surgeon has to read
A first facelift starts with tissue in its original layers. A revision does not. Before planning, the surgeon has to evaluate four things the practice names:
- Scar tissue left by the earlier operation.
- Remaining skin, since the first operation removed excess skin and the second has to work with what is left.
- Prior technique, because a mini facelift, a SMAS lift and a deep plane lift each work at a different depth.
- Current goals, which may differ from the goals that drove the first surgery.
The practice’s pricing guidance singles out revision work as adding to the complexity of the surgery. Patients should expect a detailed consultation, and they should expect a surgeon to say so if a revision cannot deliver what they want.
The case for experience
Dr. Lapuerta’s central message to patients concerns surgeon selection. In his words: “Experience performing the cosmetic procedure of interest is the best determinant or correlate to a positive surgical outcome as perceived by patients.” In his view, the best way to improve the odds is a board-certified surgeon with extensive experience measured in both number of cases and years.
That argument carries extra weight in a revision, where the surgeon works with altered anatomy and has to judge what an earlier operation changed. Dr. Lapuerta points to more than 30 years of practice and more than 30,000 surgical and non-surgical procedures. He holds certification from the American Board of Plastic Surgery, the American Board of Surgery and Surgery of the Hand.
He also teaches the next generation of plastic surgeons as faculty serving UT-Houston Plastic and Reconstructive Surgery, the University of Texas Medical Branch in Galveston and the Plastic and Reconstructive Surgery Fellowship at Houston Methodist Hospital. At St. Joseph Hospital he serves as Chairman of Plastic Surgery.
Safety and the second operation
A revision is still a facelift, with the same requirements around anesthesia and the operating room. Many facelifts take place under general anesthesia. Dr. Lapuerta owns and operates a QuadA (AAAASF) accredited surgical facility and works only with physician anesthesiologists, never nurse anesthetists or anesthesia assistants. He holds privileges in the Memorial Hermann network, at HCA hospitals including The Woman’s Hospital of Texas and at St. Luke’s Houston Medical Center.
Recovery follows the familiar pattern of swelling and bruising that peak in the first few days, then settle over the following weeks as incisions improve and scars mature. Every facelift carries risks, and a second operation on the same tissue deserves a frank conversation about them.
Patients considering a revision can bring photos and records from the first surgery to the consultation. Those details help tell the surgeon what technique the earlier operation used, one of the four factors any revision plan has to account for.
This article is for general information only and is not medical advice. Results vary from patient to patient. Consult a board-certified plastic surgeon or your physician about your own situation. Written in partnership with Joseph Lambert, a publicist working with Leo Lapuerta, MD Plastic Surgery.