Most of us know of people who have had not just one facelift but two or three. The perception is that these people must be unbearably vain. But this is not necessarily the case. These people do not have a second or third facelift because they enjoy having facelifts. Rather, it is because the benefits have been lost. Their early facelifts may have been skin only tightening procedures. These procedures can produce a temporary drawn tight look. There is some benefit, but this is followed by skin sagging only a few years later. The skin is notorious for its ability to stretch. This was the impetus for the development of techniques that pulled tight on the inelastic connective tissue layer below the skin.

In fact, I have redone many such facelifts (See L.B. in Patient Photographs), some as soon as one to two years after the original, which was probably a skin only lift with minimal or no deep plane dissection. Even on some of my own patients treated using the deep-plane lift, I have done secondary facelifts for patients with particularly resistant jowls.

Avoiding Skin Tension

It is important when operating on the face to avoid tension on the skin because the skin stretches easily. Most people have no trouble understanding this, and the reason for using another tissue handle (the SMAS) for elevation.

People who have had three or four facelifts are not doing it because they enjoy having surgery. They are doing it because the results of a skin-only facelift have (predictably) not held up over time.