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– Cervical deformities
– Unnatural pattern of wrinkles – “static facelift stig- – Dimpled paraoral K-point (junction of different ma”
vectors of traction) with mimetic, dynamic “face- lift stigma”
– Permanent nerve damage
It is important to try not to show a difference in our reaction toward the patient if the previous surgery was done by ourselves or by another physician. We should hide any expression of shuddering or feeling of repugnance for a bad result which another physician has caused. Everybody in our profession can have complications. Otherwise, we should try to look at our own suboptimal or incomplete results with the eyes of our colleagues. Would I make an early correc- tion of this patient if he/she came from another sur- geon? If yes, then I should perform an early reopera- tion also of my own patient.
Even celebrities in our profession – the best plastic surgeons in the world – are not able to stop the bio- logical clock. Very good results after rejuvenative pro- cedures are subject to the ageing process and these faces will lose their freshness and attractiveness as time goes by. In well-performed rhytidoplasties we will have fewer problems from facelift surgery, even after 15 or 20 years. Sometimes it could be sufficient to perform only a mini or a minimal-invasive, deep- intensive (MIDI) facelift in patients of even advanced age, if the first surgery was done well.
If the first surgery was not done in a proper way, there are many reasons for reoperation:
– Insufficient effect of rhytidoplasty with laxity of both deep layer and skin
– Descended facial structures soon after initial sur- gery with a pessimistic “tired look”
– Irregular jawline – Improper scars – Displaced hairline
– Distorted or “amputated” earlobe
Secondary Facelift
Dimitrije E. Panfilov
Fig. 53.1. a A 54-year-old patient who had a facelift 12 years ago. b Dermographic markings. c Three weeks after double layer rhytidectomy, crow’s-feet sealing, and autologous fat transfer
Fig. 53.2. a, b Subauricular (instead of retroauricular) scars in a W shape; the initial facelift had been done by a dermatolo- gist! c Dermographic planning: secondary facelift correction
of eyelids, “lemon wrinkles” of upper lip, “witch’s chin” defor- mity, and platysma bands. d Before and e 6 weeks after second- ary procedure
process is different for different individuals, and its speed is different. In general, individuals with thicker skin (like men, Asian race) show later signs of ageing than those with thin skins.
If 10, 15, or 20 years has passed since the initial facelift and the patient is still healthy and “full of life”
we can indicate and perform another procedure but not because the first one had been done badly. Just the time passed has put its traces in the face. The ageing
Fig. 53.3. a Male patient with subopti- mal result of endoscopic facelift 2 years ago done in another clinic. b We have done a classic facelift and forehead lift.
c Female patient with facelift done in another clinic 3 years ago with irregu- lar jawline and neck skin laxity. d Three months after secondary facelift
Fig. 53.4. a A 62-year-old patient who had undergone a facelift 16 years ago.
b Three weeks after secondary proce- dure.
Fig. 53.4. Continued. c We have planned rhytidoplasty with superficial musculo- aponeurotic system (SMAS) resection, crow’s-feet sealing, and d scar correc- tion. Retroauricular scar e after first rhytidoplasty and f after secondary procedure. Profile of the same patient g before the operation and h 10 days postoperatively
stance volumetric improvement with autologous fat transfer.
If we face patients with facial paralysis caused through previous surgery which has not occurred re- cently, we have to employ all our skills and experience from reconstructive surgery to help these patients as well as we can.
Bibliography
Please see the general bibliography at the end of this book.
Taking care of good scars will please all patients, but it can have some unexpected “side effects”. It is our experience that some patients got the recommen- dation from their hairdresser. Certainly, they cannot judge the whole medical work we have done, but they can judge and compare scars of different surgeons. If we make unobtrusive scars, they will recommend us.
When the neck skin is not affected after primary procedure(s) we can do only minimal incisions but tighten the deep layer well. We minimize the effort and maximize the effect.
After primary facelift many new techniques have been developed; we can apply new methods to im- prove also poor results from earlier decades, for in-
Fig. 53.5. a The previous maxillofacial surgeon put too much tension onto the earlobe, which looks like it has been
“amputated”. Also there are visible pre- and retroauricular scars. b After secondary facelift we could improve scars, including a retrotragal scar;
2 weeks postoperatively. The same patient c before and d after secondary facelift; notice the volumetric improve- ment of the semiprofile contour
Fig. 53.6. a A 60-year-old patient, 8 years after primary facelift. b Mini facelift with shortened operative and recovery time (only preauricular scar)
Fig. 53.7. a Facelift stigma of “operated look” produced 22 years ago. b Slight deep-layer and neck skin correction with SMAS plication and autologous fat transfer; minimal skin resection!
Fig. 53.8. a Patient with paralysis of all three branches of the facial nerve, when a bilateral facelift with resection of neurofibromas was performed 30 years ago. b Patient after second stage of reconstruction. c Dermo- graphic planning. d Left preoperative side view of the patient
Fig. 53.8. Continued. e Left unilateral minimal-invasive, deep- intensive (MIDI) facelift with extirpation of neofibromas, cantopexy, and f elevation of the left mouth angle. Her mouth
g before. and h after second-stage reconstruction. Her eyes i before and j after cantopexy and resection of skin and neu- rofibromas
