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Why Some Patients Need a Revision or Secondary Facelift
20th January 2026
A revision facelift, also known as a secondary facelift, is a surgical procedure designed to address concerns that arise after an initial facelift operation. Whether you’re experiencing unsatisfactory results from your first procedure, natural ageing has progressed, or complications have occurred, a revision facelift offers an opportunity to refine and improve your facial appearance.
A revision facelift is more complex than a primary facelift due to altered anatomy, scar tissue, and previously repositioned facial structures. This procedure requires a surgeon with extensive experience and a nuanced understanding of facial aesthetics to achieve natural-looking, harmonious results.
Unlike a first-time facelift performed on untouched tissue, revision surgery must work within the constraints of previous incisions, altered blood supply, and scar tissue formation. This makes the procedure technically more demanding and requires a surgeon who can navigate these challenges whilst achieving aesthetically pleasing outcomes.
Not all facelift outcomes meet patient expectations. You may be dissatisfied with various aspects of your results, including:
Asymmetry – One side of the face may appear different from the other, creating an unbalanced appearance that can be noticeable in photographs or mirrors.
Overly Tight or “Pulled” Appearance – An excessively tight result can create an unnatural, windswept look that immediately signals surgical intervention rather than a refreshed, natural appearance.
Insufficient Improvement – Some patients find that their initial facelift didn’t achieve the level of rejuvenation they had hoped for, with sagging or laxity remaining in certain areas.
Unnatural Contours – Issues such as visible bands, irregular skin surface, or distorted facial features can detract from the overall aesthetic outcome.
Pixie Ear Deformity – This occurs when the earlobe is pulled downward and attached to the face, creating an unnatural appearance.
Hair Loss or Altered Hairline – Excessive tension or poorly placed incisions can result in hair loss around the temples or an unnaturally high or pulled-back hairline.
Even the most successful facelift cannot stop the ageing process entirely. Over time, typically 7-15 years after your initial procedure, the effects of gravity, sun exposure, lifestyle factors, and natural facial volume loss may prompt you to consider a secondary facelift.
The skin continues to lose elasticity, underlying facial structures continue to descend, and new wrinkles and folds may develop. A revision facelift can address these changes and restore your refreshed appearance, though it’s important to understand that each subsequent procedure may yield progressively more modest improvements.
Unfortunately, complications can occur with any surgical procedure. Issues that might necessitate revision surgery include:
Visible or Widened Scarring – Whilst some scarring is inevitable, excessive or poorly healed scars can be aesthetically concerning and may require revision.
Nerve Damage – Temporary or permanent nerve injury can affect facial movement or sensation, and whilst some cases resolve spontaneously, others may require surgical intervention.
Skin Irregularities – Contour irregularities, dimpling, or areas of skin necrosis (tissue death) may develop and require correction.
Poor Healing or Infection – Complications during the healing process can compromise results and necessitate revision surgery once complete healing has occurred.
Haematoma or Seroma – Collections of blood or fluid beneath the skin can affect the final result if not properly addressed.
Your aesthetic goals and preferences may evolve over time. What seemed ideal years ago might no longer align with your current vision or contemporary beauty standards. Additionally, advances in surgical techniques may offer improved approaches that weren’t available during your initial procedure.
Significant weight loss or gain after your initial facelift can alter facial contours and skin laxity, potentially compromising your results and making revision surgery desirable.
Revision facelift surgery presents unique challenges that distinguish it from primary procedures:
Previous surgery creates internal scar tissue that can make tissue manipulation more difficult. The normal tissue planes that surgeons rely upon during primary facelifts may be obscured or altered, requiring careful dissection and a thorough understanding of facial anatomy.
The blood vessels that nourish facial skin may have been disrupted during the initial surgery. This can limit how much the skin can be safely repositioned during revision surgery and may affect healing.
Depending on how much skin was removed or repositioned during the initial procedure, there may be less tissue available to work with during revision surgery. This can make it more challenging to achieve significant additional improvement.
The surgeon must often release previous sutures, work through scar tissue, address any complications from the first procedure, and achieve symmetry and natural contours—all whilst working within the constraints of altered anatomy.
This comprehensive procedure addresses the entire lower face, midface, and neck. It’s appropriate when widespread concerns need correction or when significant additional ageing has occurred since the initial procedure.
A less extensive procedure focusing on specific areas of concern, such as the jowls or a particular asymmetry. This may be suitable when most of the initial results remain satisfactory but isolated issues have developed.
Sometimes, specific concerns can be addressed through focused interventions:
Neck Revision – Addressing persistent or recurrent neck bands, excess skin, or contour irregularities in the neck area.
Temporal or Brow Revision – Correcting issues with the upper face, temples, or hairline.
Scar Revision – Specifically improving the appearance of visible or problematic scars from the initial procedure.
Revision facelifts are often combined with additional treatments to optimise results:
Fat Grafting – Restoring volume to areas that appear hollow or deflated, creating more youthful contours.
Laser Resurfacing or Chemical Peels – Improving skin texture, tone, and quality.
Blepharoplasty (Eyelid Surgery) – Addressing ageing changes around the eyes that may have occurred since the initial facelift.
Brow Lift – Correcting a descended or asymmetric brow position.
Facial Implants – Enhancing structural support in areas such as the cheeks or chin.
Ideal candidates for revision facelift surgery typically meet several criteria:
You should be in good physical health without medical conditions that could significantly increase surgical risks or impair healing. This includes having well-controlled chronic conditions and being a non-smoker or willing to quit well in advance of surgery.
Understanding what revision surgery can and cannot achieve is crucial. Whilst significant improvements are often possible, revision surgery may have limitations compared to primary procedures, and outcomes depend on factors including skin quality, extent of previous surgery, and individual healing.
It’s generally advisable to wait at least 12 months after your initial facelift to allow complete healing and for final results to manifest. Some surgeons recommend waiting even longer, particularly if complications occurred. This waiting period allows inflammation to resolve, scars to mature, and tissues to stabilise.
You should have clearly defined concerns that can be realistically improved through revision surgery. During your consultation, your surgeon will assess whether your goals can be achieved.
Revision facelift recovery may be more demanding than your initial experience. You must be willing to follow post-operative instructions carefully, attend all follow-up appointments, and allow adequate time for healing.
It’s important to have realistic emotional expectations and to pursue revision surgery for yourself rather than to please others. If you experienced significant distress from your initial procedure, discussing your concerns openly with your surgeon is essential.
Your consultation is crucial for achieving successful outcomes and should be thorough and comprehensive:
Your surgeon will review your complete medical history, including details of your initial facelift (surgeon, date, technique used, any complications), current medications and supplements, previous and current medical conditions, lifestyle factors including smoking and alcohol consumption, and any allergies or adverse reactions to anaesthesia or medications.
If possible, bring operative notes, before-and-after photographs, and contact information for your previous surgeon. Whilst some patients feel hesitant about this, most revision surgeons appreciate having this information to better understand your unique situation.
Your surgeon will carefully examine your facial structure, skin quality and elasticity, scarring from the previous procedure, facial symmetry and proportions, underlying tissue support, and areas of specific concern.
Photographs will be taken from multiple angles to document your current appearance and assist with surgical planning.
This is your opportunity to clearly communicate what aspects of your previous facelift concern you and what you hope to achieve with revision surgery. Be honest and specific about your expectations.
Your surgeon will explain what can realistically be achieved, any limitations based on your individual anatomy and previous surgery, and alternative or complementary approaches that might help you achieve your goals.
Your surgeon will explain the recommended surgical approach, including which techniques will be used, whether the procedure will address the full face or specific areas, the expected extent of incisions and whether they’ll differ from your initial procedure, and whether additional procedures are recommended.
All surgery carries risks, and revision facelift surgery may have additional considerations:
Risks specific to revision surgery include increased risk of skin necrosis due to compromised blood supply, potential for more extensive scarring, longer recovery time, possibility of persistent asymmetry or irregularities, and need for further revision in some cases.
General facelift risks include bleeding and haematoma, infection, nerve injury affecting facial movement or sensation, anaesthesia complications, poor scarring, skin loss, and dissatisfaction with aesthetic results.
Your surgeon should discuss these risks candidly and explain how they’ll be minimised.
Proper preparation can significantly impact your surgical outcome and recovery:
Stop smoking at least 4-6 weeks before surgery, as smoking severely compromises blood flow and healing. Discontinue certain medications and supplements that can increase bleeding risk, such as aspirin, anti-inflammatory medications, and some herbal supplements. Your surgeon will provide a specific list.
Arrange for any required medical clearances or tests. Ensure chronic medical conditions are well-controlled.
Arrange for someone to drive you home after surgery and stay with you for at least the first 24-48 hours. Prepare your home with necessary supplies including prescribed medications, ice packs, clean towels and pillowcases, comfortable button-up shirts, and easy-to-prepare nutritious foods.
Arrange time off work—typically 2-3 weeks minimum, though this varies by individual and the extent of surgery.
Ensure you have a clear understanding of the planned procedure and realistic expectations. Prepare yourself mentally for the recovery process, which may be more challenging than your initial facelift. Consider arranging support from friends or family, as recovery can be emotionally as well as physically demanding.
Revision facelifts are typically performed under general anaesthesia, though some less extensive procedures might be done with sedation and local anaesthesia. Your anaesthetist will discuss the best option for your specific situation.
The specific technique will depend on your individual needs, but generally involves:
Incision Placement – Usually following the initial incision lines, though modifications may be necessary to address scarring or achieve optimal results. Incisions typically extend from the temple, around the ear, and into the hairline behind the ear.
Tissue Dissection – Carefully working through scar tissue from the previous procedure to access underlying facial structures. This is often the most technically demanding aspect of revision surgery.
SMAS Layer Manipulation – The SMAS (superficial musculoaponeurotic system) layer, which provides structural support, may be repositioned, tightened, or reinforced. In revision cases, this layer may have scarring or may need different handling than in primary procedures.
Skin Redraping – Once underlying structures are repositioned, excess skin is carefully redraped and trimmed. The surgeon must balance achieving improvement with maintaining adequate blood supply to the skin.
Closure – Meticulous closure in layers to minimise tension on the skin and optimise scar healing.
Additional Procedures – If fat grafting, laser resurfacing, or other complementary procedures are being performed, they’ll be completed during the same surgical session.
Revision facelift surgery typically takes 3-6 hours, depending on the extent of the procedure and whether additional treatments are being performed. Revision procedures often take longer than primary facelifts due to the technical complexity.
You’ll wake from surgery with bandages around your face and possibly surgical drains to prevent fluid accumulation. Expect significant swelling and bruising, which may be more pronounced than with your initial facelift. Discomfort is typically manageable with prescribed pain medication.
You’ll need to keep your head elevated, even when sleeping, to minimise swelling. Most surgeons recommend sleeping in a recliner or propped up on pillows at a 30-45 degree angle.
Drains, if used, are usually removed within 1-3 days. Initial bandages may be replaced with a lighter compression garment.
Sutures are typically removed 5-10 days after surgery. Swelling and bruising gradually improve, though you may still have noticeable residual swelling. Most patients feel comfortable returning to work and light social activities by 2-3 weeks, though this varies.
You’ll be advised to avoid strenuous activity, heavy lifting, and bending over. Gentle walking is encouraged to promote circulation.
Swelling continues to subside, and results become more apparent. You can gradually resume normal activities, including exercise, as approved by your surgeon. Some residual numbness or tightness is normal and typically improves over time.
Scars will be pink or red during this phase but will gradually fade over the coming months.
Final results become apparent as residual swelling completely resolves and tissues settle. This can take 6-12 months or occasionally longer with revision procedures. Scars continue to mature and fade, eventually becoming thin, pale lines that are typically well-concealed within the natural contours of the face and hairline.
Any residual numbness usually resolves, though some patients experience permanent areas of altered sensation.
To optimise and maintain your revision facelift results:
Follow All Post-Operative Instructions – This cannot be overstated. Compliance with your surgeon’s guidance is crucial for optimal healing.
Protect Your Skin from Sun Exposure – UV damage can compromise results and worsen scarring. Use broad-spectrum sunscreen daily and wear protective clothing and hats.
Maintain a Stable Weight – Significant fluctuations can affect your results.
Adopt a Good Skincare Routine – Quality skincare can help maintain your results. Your surgeon may recommend specific products or treatments.
Consider Non-Surgical Maintenance – Treatments such as Botox, dermal fillers, laser treatments, or chemical peels can complement your surgical results and extend their longevity.
Live a Healthy Lifestyle – Avoiding smoking, limiting alcohol, eating a balanced diet, staying hydrated, and managing stress all contribute to healthy, youthful-looking skin.
Whilst most revision facelifts proceed without significant complications, it’s important to be aware of potential issues:
A collection of blood beneath the skin, occurring in 1-3% of facelift patients. Small haematomas may resolve on their own, whilst larger ones may require drainage. Prompt treatment is important to prevent complications.
Rare but requiring immediate treatment with antibiotics and possibly surgical drainage. Signs include increasing pain, redness, warmth, or discharge.
Areas of skin that don’t receive adequate blood supply may become damaged. This is more common in revision cases and in smokers. Treatment depends on the extent and may include wound care, debridement, or additional surgery.
Temporary numbness or weakness is common and usually resolves within weeks to months. Permanent nerve injury is rare but possible. Your surgeon should discuss specific risks based on your individual anatomy.
Whilst efforts are made to minimise scarring, some patients develop thick, raised, or widened scars. Scar revision techniques or treatments such as steroid injections or laser therapy may help.
Despite best efforts, some asymmetry may persist or develop. Minor asymmetry is normal in all faces, but significant asymmetry may require additional correction.
Not all patients are satisfied with their outcomes. Open communication with your surgeon throughout the process and realistic expectations are crucial. In some cases, additional revision may be considered after appropriate healing time.
Revision facelift surgery is typically more expensive than primary facelift procedures due to the increased complexity and time required. Costs may include:
During your consultation at Linia Cosmetic Surgery, you’ll receive a detailed cost breakdown specific to your individual surgical plan. Revision facelift surgery is considered cosmetic and is not typically covered by the NHS or private insurance, though financing options may be available.
It’s important to prioritise surgeon experience and qualifications over cost when choosing a revision facelift surgeon, as this complex procedure requires advanced skills and expertise.
Selecting a qualified, experienced surgeon is perhaps the most important decision you’ll make:
GMC Registration – Ensure your surgeon is registered with the General Medical Council and, ideally, on the specialist register for plastic surgery.
Relevant Training and Experience – Look for a surgeon with extensive experience specifically with revision facelift procedures, not just primary facelifts. Ask how many revision facelifts they perform annually.
Hospital Privileges – Your surgeon should have operating privileges at an accredited hospital, which indicates they’ve met rigorous credentialing requirements.
During consultations, don’t hesitate to ask:
Be cautious if a surgeon:
Choose a surgeon with whom you feel comfortable communicating openly. You should feel that your concerns are heard, your questions are answered thoroughly, and your goals are understood and respected. Trust your instincts—if something doesn’t feel right, it’s appropriate to seek additional consultations.
Posted In: Face Treatments Blogs
Written By: Firat Ekinci
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