Avoiding and Correcting the Over-Operated Facelift

The most predictable comment I get from patients inquiring about facial rejuvenation surgery is one that expresses their fear of looking over-operated, weird, or like any number of celebrities that have had either bad surgery or just too much of it (Joan Rivers, Kenny Rogers, etc.).  They’ll often recount stories of their friends who have undergone similar undesirable changes.  So how common is this, how can it be avoided, and what can be done to fix it?


For someone who has never had any facial rejuvenation surgery to get an over-operated look after their first facelift is, frankly, rare, even with a heavy-handed surgeon .  I pride myself in striving for a natural look and would rather contend with the unlikely but relatively simple issue of “doing a little more” afterward than trying to undo something that cannot easily be undone.  However the real problem is when an aggressive approach is done on someone who has had a facelift (or facelifts) in the past.


Although the skin is a poor structural support for even a first (primary) facelift, to rely on it for a lasting and natural look during a later (secondary) facelift is a bad idea in my opinion.  The risk of worsening or creating facelift stigmata such as a windblown look, joker lines, and disharmonies of skin tension in different areas of the face, are too great.  Even the deeper tissues that do the work of a primary facelift, namely the SMAS layer in the cheek and platysma muscle in the neck, may no longer have the ability to support the desired facial 3-dimensional shape in a secondary facelift situation.


To avoid problems in a secondary facelift, as well as to help undo some over-operated problems, I often do other procedures that specifically avoid pulling on or removing any additional skin.  These procedures can be deep plane or subperiosteal facelift techniques, such as using Endotines for midface support to correct a “hammock” appearance of over-operated cheek folds.  Fat injection is a very effective technique to restore volume to the face that has been lost due to aging or to misguided original surgery that may have removed volume from the face with liposuction for example.  It also tends to have a salutary effect on the skin overlying the fat injected areas.


There are many other procedures that can be done to help correct for other facelift problems such as pixie-ear deformity, effacement of the tragus (that little cartilage piece in front of the ear), or scars that were placed or migrated in front of the ear and onto the cheek.  Correction of the over-operated or over-injected lip probably deserves its own blog piece – I’ll plan that next!


Douglas J. Mackenzie, M.D., F.A.C.S.

Douglas J. Mackenzie, MD

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