Experienced surgeons discuss preferred revision rhytidectomy techniques

August 01
By Rochelle Nataloni

Revision surgery and dissatisfaction are like peanut butter and jelly. While they certainly exist independently, one is often associated with the other. Rhytidectomy is unique among revision procedures because it’s not always coupled with a problem or dissatisfaction. The aging process prompts a particular contingent of facelift patients to present years after their primary surgery requesting more of the same.

“These patients feel they have enjoyed a worthwhile benefit from their original investment, but find that aging has again caught up with them and they would now like to enjoy a similar — or enhanced — benefit again,” says Washington, cosmetic and plastic surgeon J. William Little, M.D.

Of course, there are other rhytidectomy patients, as well. Another contingent of facelift revision candidates presents much earlier — typically within a year or two of their original procedure… these patients are fundamentally unhappy.


When extensive experience in facelift revision surgery is sought, Neil Gordon, M.D., is often considered the “go-to” guy. He is a clinical assistant professor of surgery at Yale University School of Medicine, New Haven, Conn., and the director of head and neck aesthetic surgery and coordinator of education in facial plastic and reconstructive surgery in the section of otolaryngology, department of surgery. He has been referred to by an iconic fashion and beauty magazine as the surgeon to seek for those who are “over-pulled or underwhelmed.”

Dr. Gordon’s practice is dedicated strictly to facial surgery, and 35 percent of the procedures he performs are revisions. He stresses the importance of avoiding skin tension at all costs in rhytidectomy. “In people who have had facelifts, in most situations, the skin has already been tightened, so the technique that is essential in revisions has to be one that can mobilize or move droopy soft tissue back into place without using the skin as the mechanism of the lifting,” he says. “These people have had their skin tightened once, and if they were overdone, they have had their skin tightened too much, so anything that would tighten their skin further would worsen the problem.”