Secondary Facelift

Q: Dr. Eppley, I have a facelift question. You did a secondary facelift on me from an initial facelift done one year ago by another surgery. While the terrible scars from around my ears are now gone, I noticed that the remaining horizontal scar across my sideburn (which we left along to manage later) has not really change in position much. I don’t understand the vectors of tissue lifted in facelift surgery. Is can you explain it to me.

A: In facelift surgery what happens to the SMAS does not translate in a 1:1 relationship to the skin. The whole purpose of SMAS manipulation is to take tension off of the skin to prevent scar widening and to hold up the results longer. Its purpose is not to allow a lot more skin to be removed particularly on a secondary basis. In fact it is quite the opposite. Its role is to allow facial tightening so that the scars can be removed with the least amount of skin removal that will not create recurrent adverse scarring or distort the hairline or earlobes. This is particularly relevant in a secondary facelift that was done in a relatively short time after the first. Your secondary facelift goals were to eliminate the wide scarring and prevent its recurrence and tighten the underlying tissues better to support that effort. Thus I would not expect the horizontal location of the preauricular back cut to change in any significant way. This would be very different if the secondary facelift is done 7 or 10 years later when significant skin laxity had returned and more aggressive skin removal was warranted. Being a male with thicker skin with more pigment you can see what happens when skin removal is done by itself when its elastic limits are exceeded and its movements are not supported underneath it.

Dr. Barry Eppley
Indianapolis, Indiana