Revision Facelift: What to Know Before Considering a Second Surgery

Your facelift was supposed to be a fresh start—tighter jawline, lifted cheeks, a more youthful appearance. But now, whether it's been a few months or a few years, you’re noticing changes. Maybe the results didn’t turn out quite the way you envisioned, or perhaps the natural aging process has crept back in faster than expected.

This is where a revision facelift—also known as facelift revision surgery or a secondary facelift procedure—comes in. Revision surgery is about refining, correcting, or enhancing the results of your initial facelift, but it’s also a more complex process that requires careful consideration.

If you're thinking about a facelift revision, here’s what you need to know—from who makes an ideal candidate to what you can (and can’t) expect from a second round under the knife.

Aging After a Facelift – Understanding Long-Term Changes

One of the biggest misconceptions about facelift surgery is that the results will last forever. While a primary facelift can provide a decade or more of rejuvenation, the natural aging process continues. Skin continues to lose collagen and elasticity, facial fat shifts over time, and the effects of gravity, sun exposure, and lifestyle choices will all influence how long the results last.

What Happens to the Face Over Time?

• Skin Laxity Returns – Even after a successful facelift, the skin will continue to lose firmness due to collagen depletion.
• Volume Loss Continues – As facial fat decreases or shifts, areas that once appeared full may begin to hollow.
• Neck and Jawline Changes – Over time, loose skin can develop again, particularly along the neck and jawline.
• Bone Structure Shifts – The facial bones slightly recede with age, which can subtly impact the contours of the face.

How Long Do Facelift Results Last?

• Traditional SMAS facelift: 7-10 years
• Deep plane facelift: 10-15 years
• Mini facelift: 5-7 years

A revision facelift can correct age-related changes after a previous procedure, but it’s important to understand the natural course of facial aging to set realistic expectations.

Why Do Some Facelifts Fail?

One of the most common reasons for seeking a revision facelift is dissatisfaction with the results of a previous facelift. But why does this happen?

The Most Common Causes of a Failed Facelift:

1. Overly Tight or “Windblown” Appearance
   • If too much skin was pulled, or the procedure focused only on the skin without addressing the underlying muscle and tissue layers (SMAS or deep plane techniques), the result can look unnatural.
2. Insufficient Lifting or Recurrence of Sagging
   • Some older facelift techniques only lifted the skin, rather than the deeper muscular structure (SMAS or deep plane), leading to short-lived results.
3. Visible Scarring or Pixie Ear Deformity
   • Poor incision placement or excessive tension on the skin can cause noticeable scars or pixie ear deformity, where the earlobes look stretched onto the face.
4. Neck Banding or Cobra Neck Deformity
   • Some facelifts fail to properly address the platysma muscle, leaving behind prominent neck bands.
5. Fat Loss and Hollowed Appearance
   • Some patients experience fat loss in key areas of the face, making their results appear hollow or aged prematurely.

A revision facelift can address these issues, restoring a more natural, refined, and youthful appearance.

Who Needs a Revision Facelift?

Not every patient who has undergone facial plastic surgery will need a revision, but some do. A secondary facelift may be necessary if:

• You had a facelift and aging has continued. Some primary facelifts are done in a patient’s 40s or early 50s based on anatomy and patient history, meaning that by their late 50s or 60s, the skin has continued to lose elasticity. For some patients this more aged appearance is something they want addressed again.
• The technique of your first facelift was outdated or not correct for your anatomy. Earlier facelift techniques focused primarily on tightening the skin, but modern methods go deeper, repositioning facial muscles and soft tissue for longer-lasting results. If your initial procedure was too superficial, you may need a revision facelift to correct lingering sagging or unnatural tightness.
• Your facelift didn’t heal well. Whether due to genetics, medical conditions, or external factors like smoking or sun exposure, some people don’t heal as expected after facelift surgery. This can lead to scarring, pixie ear deformity (when the earlobe looks pulled or stretched), or other contour irregularities.
• You have complications from your first facelift. Some patients develop cobra neck deformity, where the neck bands appear too prominent, or experience residual fat loss that creates a hollowed appearance. Revision facelift, Fat grafting, laser resurfacing, and strategic revisions can correct these concerns.

Things to Consider Before a Revision Facelift

1. The Complexity of Revision Surgery

A secondary facelift procedure is not just a repeat of the first. The presence of scar tissue from the initial facelift makes dissection more challenging, and adjustments must be made based on what was previously done. This is why it’s essential to seek out an experienced facelift surgeon—one with extensive expertise in revision surgery.

2. What Can Be Achieved vs. What Cannot

A facelift revision can refine facial features, lift fallen cheek pads and jowls, smooth out excess skin, and correct asymmetries. However, it’s not a cure-all for every cosmetic concern. For example:

It cannot stop aging. Even the best revision facelift surgery won’t prevent the natural aging process—but it can turn back the clock a decade or more.

It can correct contour issues. Hollowed cheeks? Uneven jawline? These can often be improved with fat grafting or minor surgical adjustments.

It may not fully restore elasticity in extremely aged skin. If your skin has significant laxity, you may need a combination of surgical and non-surgical facial rejuvenation procedures (like chemical peels or laser skin resurfacing) for optimal results.

It can improve scarring and ear positioning. Many facial plastic and reconstructive surgeons use laser resurfacing, steroid injections, and scar revision techniques to improve incision lines.

3. The Emotional Consideration of a Revision Facelift

Let’s be real: going through facial plastic surgery again can feel daunting, especially if your first experience left you less than thrilled. It’s normal to feel hesitant, but remember, a revision can be a second chance—not just at improved results, but at a better overall experience with a surgeon who understands your goals.

Comparing a Revision Facelift to Non-Surgical Alternatives

Not everyone who is dissatisfied with a primary facelift needs a full revision facelift surgery. In some cases, non-surgical facial rejuvenation may be enough to refresh your look without another operation.

When Non-Surgical Options May Be Enough:

• Mild sagging or volume loss
• Fine lines and wrinkles that reappear after a facelift
• Minor contour irregularities that do not require surgical correction

Common Non-Surgical Alternatives to a Revision Facelift:

• Dermal Fillers – Restore lost volume in the cheeks, temples, and jawline.
• Fat grafting – Replace lost facial volume with your own fat cells.
• Botox or Dysport – Softens wrinkles and prevents deep lines from forming.
• RF Microneedling (Radiofrequency Microneedling) – Tightens skin and improves texture without surgery.
• Skin Resurfacing – Improves skin texture and minimizes fine lines.

While these treatments can delay the need for a revision facelift, they are not permanent solutions. Patients with significant skin laxity, contour irregularities, deep wrinkles, or shifting facial structures will likely require surgical intervention.

What to Expect During a Revision Facelift

Choosing the Right Surgeon

Unlike your primary surgery, a revision facelift requires an extra level of surgical skill. A board-certified facial plastic surgeon with expertise in revisional surgery is crucial, as they must navigate scar tissue, work with altered facial structure, and deliver a result that looks natural—not overcorrected.

Surgical Techniques Used in a Facelift Revision

Depending on your needs, your surgeon may use one or more of the following techniques:

• Deep Plane Facelift – Lifts deeper tissues for a more natural, long-lasting result.
• SMAS Facelift – Adjusts the underlying muscles without pulling the skin too tight.
• Fat Grafting – Restores lost volume in the cheeks, temples, and under-eyes.
• Scar Revision – Improves the appearance of previous incisions, often combined with laser resurfacing.
• Correcting Pixie Ear or Cobra Neck Deformities – Using more targeted surgery to improve these areas, like adjusting earlobe position or focusing only on neck contours for a more natural appearance.

Recovery: How Different Is It from a Primary Facelift?

How Long Does It Take to Heal?

Because revision surgery involves working around scar tissue, optimal healing may take slightly longer than a primary facelift. Expect:

• Swelling & Bruising: Peaks in the first 7-10 days, then gradually subsides.
• Stitches Removal: Finishes around 10-14 days post-surgery.
• Final Results: Typically visible within 6-12 months as the skin quality and deeper tissues settle.

What Can You Do to Improve Healing?

Your surgeon may recommend:

• Gentle lymphatic massage to reduce swelling.
• Avoiding smoking & alcohol to promote complete healing.
• Follow a healthy diet to nourish your body as you heal.
• Laser resurfacing or chemical peels for skin texture improvement.
• Sun protection & medical-grade skincare to maintain your results.

How to Maintain Your Results After a Revision Facelift

Undergoing a facelift revision is a significant investment of time, energy, and resources. To maximize the longevity of your results, it’s crucial to follow a long-term maintenance plan.

Post-Surgery Maintenance Tips for Long-Lasting Results:

Invest in Medical-Grade Skincare

• Using retinoids, vitamin C, and peptides helps stimulate collagen production and maintain skin elasticity.

Use Sunscreen Daily

• UV rays break down collagen and cause premature aging. SPF 30+ sunscreen is a must.

Stay Hydrated & Eat a Nutrient-Rich Diet

• Collagen-boosting foods like salmon, berries, leafy greens, and nuts help maintain skin firmness.

Consider Non-Surgical Touch-Ups

• Treatments like Botox, fillers, microneedling, or laser resurfacing can help prolong revision facelift results.

Maintain a Stable Weight

• Weight fluctuations can impact facial volume and skin tightness, altering the results of your facelift.

Aging will continue, but with proper care, revision facelift results can last 10-15 years or more.

Final Thoughts: Is a Revision Facelift Right for You?

If you're dissatisfied with your facelift results—or if the aging process has simply caught up with you—revision facelift surgery could be the answer. The key is to approach it with realistic expectations, a clear understanding of what’s possible, and the guidance of an experienced facelift surgeon who specializes in revision surgery.

Want to explore your options? Consulting with a board-certified facial plastic surgeon is the first step. With the right strategy, a secondary facelift can help you reclaim the refreshed, more youthful appearance you were hoping for.