Ten years of experience with secondary and tertiary cervicofacial lifting: A retrospective study of 360 procedures

Background: As society values youth and longevity rises, more patients seek secondary or tertiary facelifts. Published case series on these procedures are rare. This study examines primary, secondary, and tertiary facelift performed by Senior author Dr. Míchel Pfulg over a decade. Methods: All cervicofacial lifting cases by the Senior author from 2012 to 2022 were reviewed, documenting age, techniques, and concurrent procedures. Complications and longevity across primary, secondary, and tertiary procedures were compared. The author's surgical technique was outlined. Results: A total of 256 patients underwent 360 cervicofacial lifting procedures, including 256 primary, 89 secondary, and 15 tertiary facelifts. SMASectomy combined with neck liposuction was the most common procedure. Upper blepharoplasty and lipostructure were the top associated procedures in 31% and 19% of cases, respectively. Complications occurred in 4.6% of cases, with no significant correlation between complication rates and the number of facelifts performed. The average ages for the first, second, and third facelifts were 56, 64, and 67 years, respectively. The average intervals between the first and second facelifts and between the second and third were 13 and 8 years, respectively, with a statistically significant difference. Conclusions: Secondary and tertiary facelift procedures are increasingly common in treating aging. Understanding the aging process and tissue restoration after surgery is key to achieving optimal results. This study shows that these procedures have low complication rates similar to primary facelifts, although results may not last as long. Achieving consistent and satisfactory outcomes in secondary and tertiary facelifts depends on individualized patient assessment, tailored surgical planning based on previous procedures, and meticulous intraoperative execution.