Secondary Facelift with Deep Plane Technique in Turkey

Secondary facelift — revision surgery after a previous facelift — is technically more demanding than primary surgery. It requires operating in a previously dissected field, managing scar tissue, and often correcting the specific limitations of the prior technique. Deep plane is frequently the approach of choice for secondary cases precisely because it operates in a plane not previously disturbed.

— Dr. Umut Zereyak

Who undergoes secondary facelift?

Patients who return for secondary facelift typically fall into one of three groups:

• Natural aging after primary facelift: Results from a well-performed facelift typically last 7–10 years. As gravity and tissue aging continue, the nasolabial fold deepens again and jowling recurs. These patients had a good primary result that has simply run its course.
• Inadequate primary technique: Patients who had a SMAS plication, skin-only, or limited facelift that produced minimal improvement. They are seeking deeper correction — often specifically requesting deep plane technique after researching what their first surgery lacked.
• Complications or unsatisfactory results: Patients with visible scarring, asymmetry, pixie ear deformity, hairline distortion, or an overtightened "windswept" appearance from a previous facelift. These are the most technically challenging cases.

The surgical approach differs substantially between these groups — a secondary lift after a well-performed deep plane is a fundamentally different operation from revision of a failed skin-only facelift.

Why previous SMAS facelift complicates revision

A previous SMAS facelift creates scar tissue in the subcutaneous plane and along the SMAS surface. This makes standard skin and SMAS dissection — the approach used in primary surgery — technically more difficult. The tissue planes are adherent, the tissue is less mobile, and the risk of skin necrosis from compromised blood supply is higher.

Deep plane facelift in a secondary setting often operates in a relatively undisturbed plane. If the previous facelift was a skin or SMAS technique, the sub-SMAS plane was not entered — meaning the deep plane dissection, retaining ligament release, and composite repositioning can proceed in virgin tissue, avoiding the scarred subcutaneous plane. This is the principal advantage of deep plane for secondary cases, as described by Rohrich et al. in their work on the deep plane approach to revision rhytidectomy.

The zygomatic and masseteric retaining ligaments — the key structures released during deep plane surgery — remain intact after a SMAS-level primary facelift. Releasing these ligaments in the secondary procedure allows the malar fat pad and mid-face composite to be repositioned as effectively as in a primary deep plane case.

Correcting specific problems from primary facelift

Secondary facelift is not simply "doing the facelift again." Each revision addresses the specific anatomical problems left by the primary procedure:

Deep plane as secondary facelift: technical approach

In secondary deep plane surgery, the approach is tailored to the previous operation. Before proceeding, I need to know precisely what the primary surgeon did — which planes were dissected, whether the SMAS was plicated or imbricated, and whether there were any complications. This information guides the dissection strategy for the secondary procedure.

Key technical considerations include:

• Skin flap management: The previous skin excision leaves less skin to work with. Skin flap elevation must be more conservative, and the deep plane lift vector must compensate — repositioning deeper tissues so that the skin re-drapes without excessive tension.
• Facial nerve protection: Scar tissue from primary surgery can displace the facial nerve branches from their expected anatomical positions. Identifying the temporal and marginal mandibular branches requires additional care in a previously operated field.
• Adhesion release: Contractures and adhesions from primary surgery often contribute to the unnatural appearance. Releasing these adhesions — particularly in the nasolabial fold region and along the mandibular border — is a key step in secondary deep plane surgery.
• Blood supply preservation: The subdermal plexus may be partially compromised from primary surgery. The deep plane approach preserves blood supply to the skin flap better than repeated subcutaneous dissection, reducing the risk of skin necrosis in secondary cases.

Recovery after secondary deep plane facelift

Recovery from secondary deep plane facelift generally follows the same timeline as primary surgery — most patients return to social activities at 2–3 weeks. However, two factors may extend the recovery:

Swelling may persist longer in secondary cases due to scar tissue limiting lymphatic drainage. Patients should expect the final settling to take 4–6 months rather than the 3–4 months typical of primary deep plane facelift. Additionally, if scar revision is performed at the incision sites, these areas require additional wound care during the first 2 weeks.

Cost and assessment for secondary facelift in Turkey

Secondary facelift is priced individually — the complexity and operating time are greater than primary surgery, and pricing reflects this. A video consultation with operative notes and photographs from the previous surgery is essential before I can provide a quote. Patients seeking secondary facelift in Istanbul should bring or request their previous operative report before consultation.

Starting from a base assessment fee of Contact for pricing — specific pricing confirmed after consultation and review of previous surgical records.

Full pricing details and what's included →

References

1. Hamra ST. The deep-plane rhytidectomy. Plast Reconstr Surg. 1990;86(1):53-61.
2. Rohrich RJ, Ghavami A, Constantine FC, et al. Lift-and-fill face lift: integrating the fat compartments. Plast Reconstr Surg. 2014;133(6):756e-767e.
3. Mitz V, Peyronie M. The superficial musculo-aponeurotic system (SMAS) in the parotid and cheek area. Plast Reconstr Surg. 1976;58(1):80-88.

Further reading

• Deep plane facelift Turkey: full procedure guide →
• SMAS anatomy: the foundation of facelift surgery →
• Retaining ligaments in deep plane facelift →
• Deep plane vs SMAS: full comparison →
• Turkey vs USA: cost and quality comparison →