Eye of girl

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You had a face lift a few years ago, but inevitably age and gravity continue their work. Is it worth having another one? And how long will this one last?

    Plastic surgeon Dr. Judith Gurley says that repeated surgical facial patients are in a minority because most have one face lift, eye lift or neck life in their lifetime. Only a few will need a repeat. According to her, the No. 1 reason for a repeat procedure is dissatisfaction with the first one. “While the face continues to age, my goal is a non-surgical look to help clients age gracefully. Repeat procedures have the potential to cause an unnatural appearance,” she says. “Over-tightening is a bad idea; and repeat procedures can lead to nerve injuries that can be permanent and disfiguring.”

    Dr. Mike Nayak with Nayak Plastic Surgery adds another reason for repeat procedures: The patient was happy with the results but it’s time to do it again. He likens it to one’s position on a conveyor belt: “The belt is moving along as we age. Having a face lift is like picking you up and moving you back on the conveyor belt, farther from the end, but the conveyor continues to move,” he says. “At some point, you catch up to your old position and may want a second lift to move you back again, keeping in mind, the older we get, the faster the belt moves!”

    For those who may be unhappy with a prior procedure, Nayak says tissues heal from surgery and change shape, differently for different people, and you may not be as happy with the end result as you thought you would be. If there is more to be gained beyond the normal surgical variation, it may be worth doing. He says a 1 millimeter difference in the height of an eyebrow may be noticeable to the patient, but would be hard to fix just because of surgical and healing variability.

    Nayak says another issue that can arise in whether to redo or adjust a prior surgery is whether the problem seen from the patient’s eyes is physically and measurably a problem, or whether it’s emotionally a problem. If the face looks good to the surgeon but the patient is deeply disturbed about it, the surgeon may not be willing to take that case. He adds realistic expectations are extremely important in redoing prior surgeries, and patients must understand that plastic surgery is not a perfect science, and sometimes function must be put in front of form.

    Dr. Michele Koo with the Aesthetic Surgery Institute says face lifts may be repeated in approximately five to 10 years, with the five-year patient returning for a tweaking via a mini-lift that can often be performed in the office, or having a laser treatment to tighten and improve skin quality. “The repeat 10 to 15-year facelift patient will have a complete full or mini-lift, depending on the amount of excess skin,” she says. “My preference is doing minor procedures every few years rather than a big procedure in 10 or 20 years, because it’s more subtle and lets patients look good during that whole time instead of waiting until they look really awful.”

    Because of the danger of nerve damage and scarring, Koo does her initial face lifts with a three-zone approach: upper face, mid-face and neck. By addressing each area separately she aims to avoid the tight one-direction pull that’s the hallmark of the ‘Hollywood celebrity surgery-gone-bad.’ With her approach, the direction of tightening and tissue repositioning are natural for that region of the face.

    Sometimes, it’s not a matter of pulling more skin. The problem is loss of volume. In those cases, Koo may use fillers or fat to rejuvenate the face, rather than surgery. “Facial rejuvenation should be about repositioning and replacement for regaining the fullness of youth, rather than pulling tighter and tighter, and removing more and more skin,” she says. “Volume replacement is the secret to softening creases and deep crevices, along with replacing tissues back to their more youthful position.”