How common
- ABPS tracer data: secondary facelifts rose from 4% (2006-2014) to 18% (2015-2021) of 3,400 facelifts (PMID 38302713).
- 552 facelifts 2012-2017 in one practice: 72 revisions (PMID 32983758).
- Submandibular gland reduction was part of 13% of primary and 25% of secondary facelifts in a 736-lift series (PMID 25989302).
Timing
- Mean interval primary to secondary: 8.48 years (range 1-16) in 33 patients (PMID 9326793).
- Mean interval 11.9 years after SMAS flap facelift; 21.4% returned within 5 years (PMID 20224461).
- Systematic review, 14 articles, 737 patients: presentation 9-12 years after primary surgery (PMID 42382704).
- Sub-SMAS lift without temporal incision: 7% had a secondary facelift at mean 3.5 years (PMID 32309087).
- Delta facelift: repeat at mean 9.3 years in 9 of 283 (PMID 37619977).
Early relapse and touch-up rates
- Meta-analysis of early relapse (within 2 years): reported in 4.4% of 433 facelift papers; weighted median 2.4% (PMID 35534779).
- Tuck rate 11.4% after SMAS lifts vs 3.3% after deep-plane lifts, 634 patients (PMID 9727459).
- Revision within 18 months after reoperative sub-SMAS lift: 11.4% (PMID 35511039).
- Revision rates in recent series: 0.8% (3,964 limited-delamination deep-plane lifts) (PMID 39072376), 3.9% (MADE vertical) (PMID 22065880), 4.8% (393 endoscopic deep-plane lifts) (PMID 40576459); touch-up in 20 of 600 ponytail lifts (PMID 38152870).
What surgeons find at reoperation
- 70 reoperative sub-SMAS lifts: altered SMAS-platysma in 82.9% (fibrosis, thickness changes, limited movement, adhesions); temporary nerve injury 7.1% vs 2.2% in primary lifts (PMID 35511039).
- Systematic review: thinner SMAS, fibrosis, scarred planes; complication rates 2.0%-21.1%; temporary nerve injury up to 11.9%; overall rates comparable to primary lifts (PMID 42382704).
- Revision cases now also carry stigmata of noninvasive treatments done after the first facelift (PMID 32983758).
- Cobra neck, pixie ear and synkinesis complicate revision; deep-plane and aggressive neck surgery raise revision risk (PMID 37827505).
- Neck deformities from overtreatment of superficial structures and undertreatment of deep ones (PMID 31587772).
- Vector analysis: more intersuture vector variation in secondary lifts (16.9 vs 4.5 degrees) with similar mean vector (PMID 38657095).
Patient factors
- Secondary patients: 42.4% had a new medical problem and 57.6% a new medication since the primary lift; skin circulation generally better and tolerates more tension (PMID 9326793).
- Satisfaction slightly higher after secondary (4.49) than primary (3.97) lift (P < .06); felt 10.19 vs 9.31 years younger (PMID 9326793).
Correction of specific deformities
- Composite rhytidectomy proposed as the most effective secondary correction of hollow eyes and lateral sweep (PMID 11727849, PMID 9774028).
- Pixie ear prevention and correction techniques (PMID 39013675).
- Retightening revision after a prior MACS lift (PMID 20108092).
- Revision neck lift review, 188 cases: recurrent bands, persistent submental fullness and gland ptosis (PMID 41673281).
- Revision facelift and neck lift review (PMID 34121944).
- Secondary rhytidectomy review (PMID 21037861).
Glossary
- Secondary facelift: second facelift after a prior one (PMID 42382704).
- Revision / tuck: operation to correct or tighten an earlier result (PMID 9727459).
- Early relapse: recurrence of laxity within 2 years (PMID 35534779).
- Cobra neck: central neck deformity named as a revision challenge (PMID 37827505).
- Synkinesis: involuntary linked facial movement after nerve injury (PMID 37827505).
- Stigmata: visible signs that a facelift was done (PMID 32983758).
Papers
| PMID | First author | Year | Journal | Title | Finding |
|---|---|---|---|---|---|
| 37827505 | Ziai K | 2025 | Facial Plast Surg | Revision Rhytidectomy: Pearls and Pitfalls. | Revision rhytidectomy pearls and pitfalls |
| 38302713 | Stein MJ | 2024 | Aesthetic Plast Surg | Clinical Practice Patterns in Facelift Surgery: A 15-Year Review of Continuous Certification Tracer Data from the American Board of Plastic Surgery. | ABPS: secondary facelifts 4% to 18% |
| 35511039 | Chang KN | 2022 | Plast Reconstr Surg | Analysis of the Outcome of Reoperative Face Lifts Using Sub-SMAS Techniques. | 70 reoperative sub-SMAS lifts: nerve injury 7.1% |
| 32983758 | Skouras GA | 2020 | Plast Reconstr Surg Glob Open | Revision and Secondary Facelift: Problems Frequently Encountered. | 72 revisions in 552 facelifts; noninvasive stigmata |
| 25989302 | Mendelson BC | 2015 | Plast Reconstr Surg | Submandibular Gland Reduction in Aesthetic Surgery of the Neck: Review of 112 Consecutive Cases. | Gland reduction 25% of secondary lifts (landmark) |
| 9326793 | Guyuron B | 1997 | Plast Reconstr Surg | Secondary rhytidectomy. | Secondary rhytidectomy: 8.48-year interval, higher satisfaction (landmark) |
| 20224461 | Sundine MJ | 2010 | Plast Reconstr Surg | Longevity of SMAS facial rejuvenation and support. | SMAS facelift lasts 12 years on average (landmark) |
| 42382704 | Saad C | 2026 | JPRAS Open | Challenges and complications in secondary rhytidectomies, a systematic review. | Secondary rhytidectomy review, 737 patients |
| 32309087 | Swanson E | 2020 | Plast Reconstr Surg Glob Open | Clinical Evaluation of 225 Sub-SMAS Facelifts with No Temporal Incision. | 7% secondary at 3.5 years |
| 37619977 | Grotting JC | 2024 | Aesthet Surg J | Superior Vector Plication of the Mobile Anterior Midface: The Delta Facelift. | Delta facelift repeat at 9.3 years |
| 35534779 | Kucukguven A | 2023 | Aesthetic Plast Surg | A Systematic Review and Meta-Analysis of Early Relapse After Facelift. | Early relapse meta-analysis: median 2.4% |
| 9727459 | Kamer FM | 1998 | Plast Reconstr Surg | SMAS rhytidectomy versus deep plane rhytidectomy: an objective comparison. | Tuck rate SMAS 11.4% vs deep plane 3.3% (landmark) |
| 39072376 | Roskies M | 2024 | Facial Plast Surg Aesthet Med | Limited Delamination Modifications to the Extended Deep Plane Rhytidectomy: An Anatomical Basis for Improved Outcomes. | Limited delamination revision 0.8% |
| 22065880 | Jacono AA | 2011 | Aesthet Surg J | The minimal access deep plane extended vertical facelift. | MADE vertical revision 3.9% (landmark) |
| 40576459 | Firat M | 2025 | Aesthet Surg J | Endoscopic Deep Plane Facelift: A Classified Approach. | Endoscopic deep plane revision 4.8% |
| 38152870 | Kao CC | 2024 | Aesthet Surg J | The Ponytail Lift: 22 Years of Experience in 600 Cases of Endoscopic Deep Plane Facial Rejuvenation. | Ponytail lift touch-up 20/600 |
| 31587772 | Gordon NA | 2019 | Facial Plast Surg Clin North Am | Neck Deformities in Plastic Surgery. | Neck deformities: over- and undertreatment |
| 38657095 | Talei B | 2024 | Aesthet Surg J | Vectorial Analysis of Deep Plane Face and Neck Lift. | Vector variation in secondary lifts |
| 11727849 | Hamra ST | 2001 | Clin Plast Surg | Correcting the unfavorable outcomes following facelift surgery. | Composite rhytidectomy to correct facelift deformities (landmark) |
| 9774028 | Hamra ST | 1998 | Plast Reconstr Surg | Frequent face lift sequelae: hollow eyes and the lateral sweep: cause and repair. | Hollow eyes and lateral sweep (landmark) |
| 39013675 | Vaccari S | 2024 | Surgery | The pixie ear: How to prevent and correct it-a review of the literature. | Pixie ear prevention and correction |
| 20108092 | Tonnard P | 2010 | Aesthetic Plast Surg | Retightening revision of a previous MACS-lift meloplasty. | Retightening a prior MACS lift (landmark) |
| 41673281 | Şibar S | 2026 | Aesthetic Plast Surg | Revision Neck Lift Surgery: A Systematic Review of Indications, Techniques, and Outcomes. | Revision neck lift review |
| 34121944 | Dibbs RP | 2021 | Semin Plast Surg | Revision Facelift and Neck Lift. | Revision facelift and neck lift review |
| 21037861 | Hatef DA | 2009 | Semin Plast Surg | Secondary rhytidectomy. | Secondary rhytidectomy review (landmark) |
| 41100833 | Schultz KP | 2026 | Plast Reconstr Surg | Demystifying Deep Layer Face-Lift Techniques: A Systematic Review of Superficial Musculoaponeurotic System Techniques. | Deep plane not shown to improve longevity |
Open questions / controversies
- Relapse is reported in 4.4% of facelift papers, so true rates are unknown (PMID 35534779).
- Nerve injury in secondary lifts: 7.1% in one series (PMID 35511039) vs "comparable to primary" in a pooled review (PMID 42382704).
- Whether deep-plane primary lifts reduce later revisions: tuck-rate data from 1998 (PMID 9727459) against 2026 reviews showing no proven longevity gain (PMID 41100833).