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“The Do-Over” — Revising Previous Facelifts

 

Internationally recognized for his facelift revisions, Dr. Hamra can:

  • Correct the distortions from previous surgery

  • Correct the three distinctive signs of aging

  • Restore the look of youthful anatomy

  • Create long-lasting results

 

Shouldn't your facelift age well?

After all, you've invested time, effort and considerable resources to rejuvenate your features and update your look. You'd certainly like the new image in your mirror to last months, if not years. But what happens when your long-term expectations are met only by short-term results?

pre-op
An Aging Conventional Facelift
post composite
Youthful look restored
by the Composite Facelift

The truth is, the same facelift procedures that yield fabulous new profiles right after surgery can fade and distort before your next birthday. You may be wondering how this can happen, given the technological advances in all of plastic surgery.

The reality is that the most popular techniques, which have been done for years, are falling woefully short over time. I know. I used to do them. I see the results every day both in my office and everywhere I go. An early pleasing result frequently gives way to that “facelifted” look that everyone would rather avoid.

And disappointments continue with the “minimally invasive” procedures currently being promoted, simply because so little is done. I believe that anyone who is unhappy with a previous facelift would surely want to get it corrected if they knew that it could be easily done, and if they knew who to go to to perform the surgery.



Why Facelift Patients Are Often Dissatisfied

Each year I meet hundreds of men and women who want me to give them back the faces of their youth. Many are visiting a cosmetic surgeon for the first time. They have thought long and hard about how lifting their wrinkling skin and sagging features might also elevate their confidence and restore their self-esteem. They are anxious to match the vision they see in the mirror with the young and vibrant person they feel they still are inside. I am excited to help them.

Many people who come to me, however, aren't so optimistic. They once had the same enthusiasm for a plastic surgeon's scalpel and skill as every facelift newcomer. But they have seen the immediate, meticulous results of their surgeon's work fade over time.

patient 2 pre op oblique
Perhaps you recognize it in your own face: there's no longer the youthful harmony you enjoyed right after surgery. Instead, your lower cheeks and jawline remain tight while other areas, such as your upper cheeks and forehead, continue to fall. You see the pulls and tensions across your face, and often notice the look of a “pulled mouth.”

The area under your eyes takes on a hollow, even gaunt look, leaving you with a classic mask-like appearance. The natural reaction is to blame the surgeon. But most cosmetic surgeons are extremely capable of bringing home a beautiful, youthful contour that satisfies your vision and refreshes your looks. Blame the technique, not the surgeon.

It was not the surgeon, but the traditional old-fashioned technique that led to your current appearance.



The Same Principles Apply

The beauty of the Composite Facelift is that we can apply the same principles to correcting facial distortions as we do to prevent them in the first place. During this surgery, we manipulate the skin and underlying tissues to improve an earlier outcome in the same way we initially rejuvenate the face.
 

 

I have been able to help the majority of patients who have come to me unhappy about the long-term results of previous facial surgery. Whether they have been through one operation or many, I am happy say that they enjoy a beautiful, longer lasting result after revision surgery.

"My philosophy is that I will never agree to do revision surgery unless I can assure
the patient of significant improvement."

- Sam T. Hamra, MD

Surgery is never 100% perfect, and the need for small touch-ups is always possible. Patients understand this, and the limitations of surgery, if they have been sufficiently educated and have asked all the right questions.

patient 2 pre op oblique patient 2 pre op oblique
patient 2 pre op oblique patient 2 pre op oblique with sweep

Facial Distortions Tell the Story

As mentioned earlier, there are three distinctive signs that your facelift is not aging well: the lateral sweep, hollow eye, and malar crescent. It may be months, perhaps even years, before you see any of these, but when they occur, they distort the image you've spent thousands to restore.

These four women all show similar signs of an aging conventional facelift.

As the unsupported soft tissues of the upper face continue to age, the lateral sweep of the cheeks appears. Hollow eyes and malar crescents are also developing.

The most obvious problem associated with a standard facelift is an expression that I coined for an article I wrote in 1998, and what surgeons now commonly refer to as a lateral sweep.

lower eyelid muscles

Before
conventional

After
conventional

After
Composite

We have drawn on the lower eyelid muscle (orbicularis oculi) in the top row of these photographs. You can see that the conventional facelift did not change the position of the lower edge of this muscle. By not repositioning the lower eyelid muscle upwards, the surgeon virtually guarantees that if the malar crescent is beginning to appear, it will eventually become worse. Additionally, if the fat under the eye was not preserved, and a hollow eye is also developing, the malar crescent will be even more prominent.

Note the youthful contour achieved when the muscle is repositioned vertically with the Composite Facelift.

Considered together, these two markers (hollow eye and malar crescent) are noticeable reminders of cosmetic surgery. The maneuver I described for remedying the lateral sweep and the hollow eye also eliminates the malar crescent. Since the cheek lift elevates the whole muscle mass of the lower eyelid and cheek and secures it to the orbital bone, the results are not only dramatic, but long-lasting.

I now see ten-year follow-up patients with a stable high cheek mass. If you go through surgery, you deserve a great long-lasting result. You want something worth your time and expense.

 

Other Telltale Signs of Surgery

There are a number of distortions that scream “facelift surgery!” that aren't necessarily the result of the aging of a facelift, but are caused by the technique that was used.

 
 
 

Why Are Eyelids Such A Problem?

There are several reasons these types of eyelid problems may occur. The most common is when too much skin or too much fat has been removed, and the lower eyelid reveals too much sclera (white of the eye). This appearance is called "scleral show" and is not only unsightly, but can lead to dryness of the eye, requiring drops and ointment.

Anytime a surgeon, even an expert, operates on the lower eyelid, there is a possibility that scleral show can occur. The surgeon must be prepared to correct it—usually not a complicated operation.

patient 27 oblique post op
Two years after a secondary Composite Facelift and eyelid correction.
patient 27 oblique pre op
This gentleman had facelift & eyelid surgery 13 years earlier.
Many people with “round eyes” inherently have a degree of scleral show before surgery. As always, expectations of the end result of your procedure must be discussed with your surgeon. Today, a surgeon can control the eyelid level pretty well, but on occasion a more severe scleral show will require a more complicated correction.

Without question, the eyelid is the most complicated and often least predictable part of facial rejuvenation.



Please visit our Facelift Revision Gallery page for additional
before and after photographs of these procedures.