The reasons for facelift revision surgery vary from patient to patient. Others want to regain the impressive results of the initial procedure that they lost due to continued aging, while some need correction of hairline and ear deformities due to a poorly executed surgery.
Facelift surgeries often use an incision that starts in the hairline at the temple, which continues around the ear; however, there are “shorter versions” that lead to shorter scars. The idea is to hide them behind or within the hair-bearing scalp, and inside the natural creases of skin.
Aggressive or incorrect direction of pull is one of the causes of unnatural temporal hairline, loss of side burn and hair behind the ear, and bald patches around the incisions. While some hairstyles could camouflage them, most patients will want to correct these telltale signs of surgery.
The aforementioned problems are typically treated with hair transplantation in which hair follicles from the back of the scalp are moved to the area that needs correction or “coverage.” But to achieve impressive results and avoid the doll’s hair appearance, it is crucial to group the hair in smaller units.
Other possible methods to correct the distortion or loss of side burn and temporal hairline include scar excision surgery and skin flap rotation, with the latter being more suitable for patients who need their hairline “continuity” to be restored.
Regardless of the approach being used, it is a sacrosanct rule to use a tensionless, layered wound closure, as suggested by Beverly Hills plastic surgery expert Dr. Tarick Smaili.
Another reason for facelift revision surgery is to correct ear deformities—e.g., excess skin or too much fullness in front of the ear, pixie ear or “pulled appearance,” and visible facelift ear scars.
Fullness in front of the ear is usually corrected with a minor procedure (under local anesthesia) in which a small portion of skin is removed in front of the ear canal.
A pixie ear deformity, meanwhile, is best addressed by releasing the earlobe from the cheek skin then reattaching it in a higher position. It is also crucial to close the tension with no or very little tension on the skin to prevent the ears from stretching inferiorly.
And for the facelift ear scars that appear visible—i.e., they migrate outside the contour of the ears—treatments such as scar excision, steroid injection, silicone tapes, and topical creams could improve their appearance.