Revision Facelift
Revision facelift surgery is a transformative but challenging procedure that redefines your facial appearance or addresses concerns from previous surgeries.
What Is A Revision Facelift?
A revision facelift is a complex, highly customized procedure designed to refine or enhance results from a previous facelift, or to address new signs of aging that have emerged over time. Because prior surgery can leave scar tissue, alter facial anatomy, and impact skin elasticity, revision facelifts require exceptional surgical expertise and aesthetic precision.
Factors such as changes in facial fat pads, thinning of deeper tissue layers (SMAS), repositioned facial nerves, and even subtle shifts in the hairline or earlobes must all be carefully considered. Whether correcting visible irregularities from a past procedure or simply refreshing results that have naturally aged, the revision facelift — ideally performed using the deep plane technique — allows patients to restore youthful balance and refinement, while preserving the natural beauty and character of their face.
What Concerns Does Revision Facelift Address?
- Jowling due to sagging and drooping of the lower cheeks at the jawline
- Loose and wrinkled neck skin with excess fat that can develop under the chin and around the neck referred to as “turkey neck”
- Progressive aging years after a successful initial surgery
- Widening of the lower face
- “Plastic” look and unnatural results from previous surgery
- “Touch-ups” of minor issues after a successful initial facelift
- Visible scars or hairline step offs
- Facial nerve paralysis
- Asymmetry and imbalance
- “Cobra neck deformity”: excessive fat removal in the central portion of the neck during the initial procedure
- “Pixie ear” deformity: Earlobe distortion and lengthening
- “Windswept” look: Poor skin vector from the initial surgery
The Dr. Azizzadeh Difference
Several critical factors make patients choose Dr. Azizzadeh for their revision facelift surgery. First and foremost is safety. The anatomical changes following an initial facelift put the facial nerve and other critical structures at risk during revision surgery, especially if a deep plane facelift and neck contouring are needed.
As a leading expert in facial nerve and facelift surgery, Dr. Azizzadeh employs advanced revision facelift techniques with specialized nerve monitoring, resulting in an outstanding safety record and high success rate. Second is his extensive experience and high satisfaction rates. With over two decades in practice, Dr. Azizzadeh has the wisdom and insight to stay at the forefront of innovations in revision facelift techniques, consistently delivering superior results. Finally, Dr. Azizzadeh’s passion and artistic eye ensure optimal outcomes that are authentic, beautiful, and undetectable.
Dr. A's Insider Tips
“The success of a revision facelift depends on expertly managing scar tissue, precisely repositioning sagging glands and fat compartments, and enhancing lip aesthetics. “
Revision Facelift
Non-Surgical Alternatives
Non-surgical treatments play a critical role in maintaining and enhancing facelift results — both before and after surgery. Our Aesthetic Maintenance Program helps protect your investment, while the same treatments can be used proactively if you’re not ready for surgery.
Key non-surgical alternatives include:
Medical-Grade Skincare & Sun Protection
Daily sunscreen and clinical-grade skincare help preserve skin quality and prevent premature aging.
Injectables for Wrinkle & Volume Management
Botox®, Dysport®, Jeuveau®, Daxxify™, and fillers restore volume and soften fine lines when used conservatively.
Energy-Based Treatments
Devices like SylfirmX™ and Morpheus8™ improve skin texture and firmness when performed every 2-3 years.
Laser Resurfacing & Fat Grafting
Fractionated laser treatments and fat grafting, done every 3-5 years, address volume loss and skin tone irregularities.
Lifestyle & Nutrition
A diet rich in antioxidants, proper hydration, and stress management techniques like meditation and yoga all contribute to lasting skin health.
By combining these non-surgical treatments with expert surgical care, we help patients achieve the most refined and long-lasting rejuvenation possible.
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FAQ
It’s normal to have questions before a procedure. If you have additional questions or concerns, book a consultation today.
Revision surgery can be divided into “early” and “strategized.” Early revision surgery may be necessary to address issues from a previous facelift, such as keloid or wide scars, hairline irregularities, earlobe tension (pixie ear deformity), unsatisfactory outcome related to persistent jowling and neck laxity, and facial disharmony. Typically, we recommend waiting at least six months, and potentially longer, before undergoing an “early” revision facelift surgery. This allows sufficient time for the tissues to heal and for any residual swelling to subside.
Additionally, if you were pleased with your initial facelift results many years ago, the aging process continues. Therefore, a “strategized” revision facelift may be needed to address progressive facial aging and maintain a rejuvenated appearance. This type of revision facelift will be different than an “early” procedure since it will be a bit more holistic in nature focusing on comprehensively addressing facial aging many years after an initial procedure. Furthermore, changes in skin elasticity, health and bony skeleton will require different techniques to obtain ideal outcomes.
The primary difference between a SMAS facelift and a deep plane facelift lies in the depth and approach to lifting and repositioning facial tissues. A SMAS facelift focuses on the superficial musculoaponeurotic system, a layer of tissue beneath the skin and above the deeper facial muscles, to support the facelift without extensive undermining.
In contrast, the deep plane facelift goes deeper, involving the undermining of the SMAS and muscles to reposition the deeper facial layers and releasing the retaining ligaments.This technique targets the deep plane, allowing for a more comprehensive lift by repositioning the entire facial musculature and overlying skin as a single unit. The results can often be more elegant-looking and longer-lasting without the stigmata of “windswept” or unnaturally “tight” look.
In many cases, an initial facelift may concentrate only on the jowls and neck, neglecting the midface, eyes, and brows. This often results in a disharmonious and unnatural appearance. The most natural and authentic facial rejuvenation results are achieved when the forehead, eyes, face, nose, and neck are treated in a harmonious and cohesive manner. A revision deep plane face and neck lift focuses on the midface, lower face, and neck region, often requiring additional procedures around the eyes for optimal results. These procedures can include blepharoplasty (eyelid lift), brow lift, laser resurfacing, fat grafting, and other treatments to ensure a balanced and cohesive facial and neck rejuvenation. Your treatment plan will depend on your anatomy, the aging process since your initial surgery, and your personal goals. This comprehensive approach ensures that all areas of concern are addressed, leading to a more harmonious and natural-looking outcome.
Twilight anesthesia, also known as conscious sedation, uses lidocaine (Novocaine) to numb the facial tissues while administering sedatives and pain relievers, allowing you to remain relaxed and pain-free without needing a breathing tube. This keeps you partially awake. In contrast, general anesthesia ensures you are fully asleep during the procedure, eliminating any awareness or pain. Both anesthesia methods are suitable for a revision deep plane facelift when managed by an experienced anesthesiologist or nurse anesthetist.
In our practice, we prefer general anesthesia for these procedures. This approach eliminates the use of lidocaine, which can reduce the sensitivity of nerves and muscles, potentially compromising the accuracy of facial nerve monitoring. By choosing general anesthesia, we can ensure the highest levels of safety and precision during surgery.
Completing a deep plane revision facelift varies depending on the surgeon, patient, and the goals of the surgery. Scar tissue from the initial surgery, as well as the need to reposition the buccal fat pad, trim the submandibular glands, or perform other measures, may extend the duration of the surgery. In other instances, if the revision targets a specific issue related to the initial surgery, it may be a shorter procedure.
Non-surgical facial rejuvenation procedures like Sylfirm®, Morpheus8®, and Ulthera® are excellent for addressing limited skin laxity and keeping the skin firm after a prior facelift procedure. When combined with fillers, skin care, laser resurfacing, and Botox®/Daxxify™, they enhance skin tone, fine lines, volume, texture, and overall appearance. However, they don’t offer the same transformative results as a deep plane revision facelift, which is more suitable for advanced aging or anatomical features requiring surgical modification.
Non-surgical treatments provide minor to moderate improvements and help maintain youthfulness but can’t lift and reposition deeper facial tissues. In contrast, a deep plane facelift delivers powerful, natural results by targeting the midface, lower face, and neck’s underlying structures, addressing sagging tissues, deep wrinkles, and jowling for long-lasting, dramatic improvements.
While non-surgical procedures are extremely valuable for Dr. Azizzadeh’s “aesthetic maintenance”, a deep plane revision facelift achieves comprehensive facial rejuvenation for those with advanced aging since their primary facelift procedure. During your consultation, we will discuss your specific concerns and goals to determine the most appropriate treatment plan for your unique needs.
Preparation
For the best results and swiftest recovery, we recommend the following leading up to your procedure.
Preparing for a revision facelift involves several key phases to ensure optimal surgical outcomes and a smooth recovery. Every patient is unique, and protocols may vary, so it is crucial to consult with Dr. Azizzadeh and his team for a personalized preparation and care plan tailored to your specific needs.
Discontinue smoking, vaping, and any nicotine products, as these can impair healing and negatively impact surgical results. If you have undergone or planned any laser treatments, ensure appropriate skincare preparation. Schedule a pre-operative medical appointment with your primary care physician to evaluate your overall health. Focus on maintaining a balanced diet, staying hydrated, and engaging in regular exercise. Make arrangements for time off work and plan for necessary post-operative care. Ask Dr. Azizzadeh about temporarily stopping any non-surgical treatments, such as botulinum toxin, fillers, or biostimulators, to ensure optimal surgical outcomes.
Complete any necessary pre-operative medical clearances and tests, such as bloodwork (e.g., complete blood count and coagulation profile) and, if applicable, an EKG or chest X-ray based on age or medical history. Discontinue aspirin, anti-inflammatory medications, and certain herbal supplements that can increase the risk of bleeding. This period is also a good time to manage personal grooming needs, such as hair appointments, as these activities may be restricted after surgery.
Attend a pre-operative consultation with Dr. Azizzadeh to finalize your surgical plan, discuss expected outcomes, and review potential risks. During this visit, you will sign informed consent forms and receive comprehensive pre- and post-operative care instructions. Prepare for your recovery by stocking up on essential supplies, such as ice packs, prescribed medications, and comfortable pillows to help with head elevation. Ensure you have a responsible adult available to drive you home and assist you for at least the first 24-72 hours following surgery.
On the night before surgery, avoid eating or drinking after midnight if you will be under general anesthesia. Use relaxation techniques to ease any pre-surgery anxiety and aim for a restful night’s sleep. If prescribed, take any anti-nausea medications as directed. On the morning of your procedure, shower with antibacterial soap (if instructed) and avoid applying makeup, lotions, or skincare products. Wear loose-fitting clothing that fastens in the front for easy dressing post-surgery. Arrive at the surgical facility as instructed, typically 1 to 1.5 hours before your scheduled procedure.
Approaching your revision facelift with a positive and focused mindset can significantly enhance your experience and recovery. Feeling nervous before surgery is normal, but techniques like positive visualization, meditation, guided imagery, and mindfulness can help reduce anxiety and promote a smoother healing process. Discuss any mental preparation strategies that resonate with you with Dr. Azizzadeh and his team to incorporate them into your care plan.
By adhering to these preparation steps and working closely with Dr. Azizzadeh and his team, you can optimize your readiness for a revision facelift and enhance both your surgical outcomes and recovery experience.
Recovery
There are 4 phases to the recovery from a Revision Facelift:
During this initial phase, swelling and bruising are most noticeable but will begin to subside. You should rest but also take short walks in shaded areas outdoors to help you recover more quickly. You can usually start resuming daily activities, work, and errands towards the end of this period.
You will start looking presentable and can attend social events. However, some redness at the incision sites may still be visible. You can return to normal exercise and physical activity three weeks after surgery.
Most soft tissue healing occurs during this time. Swelling continues to decrease, and your face will look more natural. Numbness around the ear and face will normalize.
The incisions will fully heal within 12-18 months, resulting in thin, nearly invisible scars. Treatments such as scar gels, lasers, and sometimes steroid injections may be used during this time to make the incisions undetectable.
Pain Management: For most patients, pain is manageable with over-the-counter acetaminophen (Tylenol). You will also be prescribed pain medications to manage any breakthrough pain. It is important not to exceed 3 grams of Tylenol in a 24-hour period due to the risk of liver complications. Be aware that prescription medications like Percocet, Vicodin, Tylenol #3 (Tylenol with codeine), and Norco contain acetaminophen, making this dosage limit critical. Avoid ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs) as they can increase the risk of bleeding and bruising. If you experience severe pain, contact your surgeon immediately.
Medications and Supplements: To ensure optimal healing and reduce the risk of complications, avoid blood thinners and certain medications for 2 weeks before and 2 weeks after surgery. These include Aspirin, NSAIDs (such as ibuprofen, Advil, and Naprosyn), fish oil, herbal supplements, and vitamins. Additionally, refrain from smoking, vaping, all nicotine products, cannabis/marijuana, and illicit drugs during this period.
Swelling and Bruising: In the first 72 hours after surgery, use cold compresses for 20 minutes per hour while awake to reduce swelling and bruising. After this initial period, switch to warm compresses applied for 20 minutes, three times a day, to help alleviate bruising and promote healing. Additionally, you will be given arnica and bromelain to help reduce swelling and bruising. Arnica is a natural remedy known for its anti-inflammatory properties, and bromelain, an enzyme found in pineapples, helps decrease swelling and bruising. At the time of surgery, you will also receive a dose of steroids to minimize swelling. In some cases, a short course of steroids may be prescribed after surgery to manage excessive swelling. This regimen helps manage discomfort and accelerates the recovery process.
Nausea and Diet: With modern anesthesia methods and our special protocol, post-operative nausea is much less common and very manageable. During surgery, your anesthesiologist will administer intravenous anti-nausea medications and specialized anesthetics that limit gastrointestinal issues. Additionally, you will be prescribed Emend™ to take three hours before surgery to prevent nausea and Ondansetron (Zofran®) for breakthrough discomfort. Avoid complex or heavy foods 24 to 48 hours after surgery. Consume clear liquids and bland, easy-to-digest foods such as broth, plain toast, or crackers. Gradually reintroduce solid foods to ease digestion and minimize discomfort. Hydration is crucial in the post-operative period. If submandibular gland modifications are performed, follow a bland diet, avoid spices, and opt for soft foods to minimize discomfort and swelling in the neck area.
Incision Care: In the first week, gently clean your facelift and neck incisions with half water and half hydrogen peroxide once a day for the first 7 days. After cleaning, apply an antibiotic ointment, such as Neosporin or Mupirocin, over all incisions three times daily to prevent infection and promote healing. After the first week, discontinue hydrogen peroxide and antibiotic ointment. Steri-strips or silicone gel will be recommended to support further healing. For areas with crusting, applying Vaseline can keep the skin moist. Minor irregularities behind the ear are normal and may be treated with massage, scar gel or, occasionally, steroid injections.
Hair Management: In the initial phase after facelift surgery, we recommend wearing your hair down to help conceal any healing incisions. It is advisable to color your hair a few days before the surgery, and you may resume hair coloring three weeks post-surgery. Final healing can take a few weeks to several months, but you can comfortably wear your hair back in a ponytail if desired during this period. For men, special attention is given to maintaining a natural look, particularly around the sideburns and beard area. Incisions are carefully placed to ensure sideburns blend seamlessly with the natural hairline, allowing for normal shaving and grooming practices without noticeable scarring. This meticulous approach ensures a masculine and natural appearance post-surgery.
Additional Support: We recommend considering an aftercare facility following your facelift procedure. These specialized facilities offer comprehensive post-surgical care with skilled nurses, ensuring you receive the highest level of attention and support during your recovery. By choosing an aftercare facility, you can enjoy a smooth and stress-free post-operative period, allowing optimal healing and peace of mind.
Post-Surgery Warning signs: After revision facelift procedure, it is essential to monitor your recovery closely and contact your doctor if you experience any concerning symptoms. Warning signs include sudden or severe swelling, bruising that worsens instead of improving, intense pain unrelieved by prescribed medications, or any signs of infection such as fever, redness, warmth, or drainage at the incision site. Additionally, difficulty breathing, chest pain, or numbness or weakness in the face or neck should be reported immediately, as these may indicate complications. Prompt communication with your healthcare provider can ensure timely intervention and a smooth recovery process.
Healing can vary from person to person, and some individuals may experience a longer recovery period.