Revision Facelift in Londrina: Deep Plane + Deep Neck Lift

When a revision facelift is indicated: three scenarios

1. Natural refreshment 5 to 10 years after the primary

A facelift, however well executed, does not halt ageing. After five to ten years, many patients notice the gradual return of laxity: a less defined jawline, deeper folds, platysmal bands reappearing in the neck. This is not a failure of the first procedure — it is simply the clock moving forward. A revision in this context is not a correction but a natural refreshment. In most of these cases, the patient recognises the original result was good and simply wants to restore the freshness that time has softened.

2. Dissatisfaction with the primary result

The second scenario is dissatisfaction with the primary procedure, regardless of how long ago it was performed. Minimum interval before considering a revision on technical grounds: 12 months, so that tissues have fully settled and the true final result is visible. The most common complaints I see are:

• Poor jawline or neck definition — usually because the neck was not addressed in depth during the primary.
• Residual laxity — when a superficial technique was used (SMAS plication, SMASectomy, or skin-only).
• Absence of fat grafting in the primary, leaving the face looking "empty" despite the lift.
• Stretched or artificial appearance caused by excessive skin tension.
• Pixie ear — distortion of the earlobe pulled down by skin traction.
• Persistent asymmetries or irregular contours.

3. Unsightly scars from a lifting done by a non-physician practitioner

The third scenario has become increasingly common in my practice: patients who underwent a "facelift" performed by a professional who is not a medical doctor — dentists, aesthetic practitioners and other non-physicians operating outside the scope of ethical medical practice. The most frequent complaints are widened, hypertrophic or poorly positioned scars. Minimum interval before attempting revision: 1 year after the first procedure, so the scar has matured. I accept revision cases regardless of who performed the first operation — other plastic surgeons, or practitioners outside the medical profession.

The role of fat grafting in the revision facelift

Autologous fat grafting is frequently indicated in revision cases. Revision patients generally present a more pronounced degree of facial atrophy — both from the natural passage of time and, in many cases, because the primary facelift was performed without any fat grafting. Adding fat at the same operation restores lost volume and, thanks to the adipose-derived stem cells, improves skin quality and texture. This is especially valuable when the primary did not include grafting and the patient reports a "pulled but empty" face.

I use fat grafting conservatively — the goal is to replace what time has taken away, not to create volume that never existed. Zones typically addressed include the temples, the malar region, the nasolabial fold and, selectively, the tear trough.

Specific risks of the revision facelift

Revision facelift risk depends on scar tissue, previous technique, vascularity, health status, general anaesthesia and anatomy. In experienced hands, risks can be carefully managed, but revision surgery must never be presented as free of risk. The risks the patient should be aware of are:

Haematoma

Haematoma risk is reduced by the systematic use of the Auersvald haemostatic net in every facelift. Strict blood-pressure control before and after surgery, together with the interruption of anticoagulants and supplements two weeks before and after, further reduces the risk but does not eliminate it.

Facial nerve injury

Deep plane dissection requires precise knowledge of facial nerve anatomy and should be performed only by surgeons trained in this plane. The dissection is planned to respect the facial nerve branches, but transient weakness and, rarely, persistent injury are recognised risks that must be discussed during consultation.

Cutaneous vascular compromise

Cutaneous vascular compromise is uncommon but possible. The delay phenomenon — documented in Plastic and Reconstructive Surgery — may improve flap vascularisation in some secondary procedures because healing from the first surgery can stimulate new blood vessel formation.

Residual asymmetry

Possible in a small degree, usually less pronounced than the asymmetry the patient had before the revision.

How many facelifts can someone have in a person's life?

There is no absolute technical limit, but repeated facelifts increase planning complexity and should not be scheduled by calendar alone. I am aware of an American actress who had 17 facelifts across her life — a clearly exceptional case and not one I would recommend. Realistically, many patients who need revision will consider only one or two additional procedures across life, guided by true laxity, health status and tissue quality.

Investment: same fee as the primary facelift

My policy is clear: the surgical fee for a revision facelift is the same as for the primary, despite the greater technical complexity. A patient returning for a revision — very often because the primary was performed by someone else — is not penalised for the complexity they have inherited.

• First consultation: R$ 800 / approx. £115
• Follow-up consultation: R$ 400 / approx. £58
• Surgical fee: presented individually at the in-person consultation; not published online.

GBP values are approximate and subject to the daily exchange rate (BRL is the billed currency).

For reference, private revision facelift fees in the United Kingdom typically range from £12,000 to £25,000 GBP, reflecting the additional operating time and complexity compared with the primary. UK patients travelling to Londrina for a revision receive a personalised quote at the consultation, with payment terms discussed transparently. An online pre-consultation can be scheduled before travel.

Does the NHS or private insurance cover a revision facelift?

For a cosmetic indication, no. The NHS does not fund cosmetic facelift surgery, whether primary or revision, and UK private insurers (BUPA, AXA Health, Vitality, Aviva) do not cover elective aesthetic procedures. In rare cases with a documented functional component — for example, eyelid laxity obstructing the visual field, when associated with an upper blepharoplasty — an Individual Funding Request (IFR) via the local Integrated Care Board may be submitted to the NHS for the functional portion, and private insurers may review it individually. Clinical assessment is required, with documented evidence (visual-field testing when applicable). The aesthetic portion of a revision facelift is always self-funded.

Revising facelifts performed by another surgeon or by a non-physician practitioner

I accept revision cases without any restriction on who performed the first procedure. The patient does not need to return to the original surgeon. Whether the primary was done by another plastic surgeon, by a professional outside the scope of ethical medical practice (dentist, aesthetic practitioner), or using techniques such as MACS lift, PDO threads, mini-facelift, HIFU or Ultherapy, I evaluate the case and, when indicated, perform the revision with deep plane + deep neck lift.

The minimum interval is 12 months for technical dissatisfaction (so the tissues have truly settled) and 12 months for unsightly scars from a non-physician practitioner (so the scar has matured). Earlier than that, any attempt at revision is premature and may worsen the result.

For UK patients researching their options, I recommend verifying the credentials of any UK practitioner via the GMC Specialist Register and memberships of BAAPS or BAPRAS; for a Brazilian surgeon, the CRM number and SBCP or ASPS membership can be confirmed through the respective regulatory and professional bodies.

Why choose an experienced surgeon for a revision facelift

The revision facelift is technically harder than the primary. Scar tissue alters dissection planes, the previous skin redraping distorts landmarks, and correcting disappointing work made by someone else carries a higher psychological weight. A surgeon performing a revision must master:

• The deep plane technique and the deep neck lift in combination.
• Recognition and management of the scar tissue left by superficial techniques.
• Corrective manoeuvres for pixie ear, widened scars and stretched appearance.
• Autologous fat grafting in the same session, when indicated.
• The Auersvald haemostatic net to reduce haematoma risk in a field that has been previously operated.

If you are considering a revision, seek a plastic surgeon with documented experience in secondary facelifts, who understands the anatomy of a previously operated face and delivers natural outcomes in real case series. For UK patients, verify Brazilian credentials (CRM number) via the regional Medical Council and international society memberships (SBCP, ASPS).