Not too long ago, facelifts were regarded as rather controversial. They were actions taken by celebrities or perhaps your grandmother in secrecy, vanishing from the public eye for weeks only to reappear with a tighter, pulled, and distinct look. Fortunately, those times have passed. Various surgical advancements have ushered facelifts into the modern era, making this plastic surgery procedure sought after even by those in their 40s. Currently, facelifts are not a one-size-fits-all solution; the subtleties and outcomes can vary significantly, depending on both the patient and the surgeon.
And in this regard, the possibility of a botched facelift has also decreased. "These days, it's much more common for someone to undergo plastic surgery for which they aren't the ideal candidate rather than having a surgery performed inaccurately or with complications," remarks Dr. Mark Mofid, a board-certified plastic surgeon in La Jolla, California. Surgical disasters are the exception rather than the rule. Nevertheless, botched plastic surgeries do occur.
When evaluating facelift results and looking for potential problem signs, the most effective approach is to examine the after photo and determine if the patient appears good. Yes, it's as straightforward as that. (And, quite frankly, it's a good guideline for assessing all types of cosmetic procedures.) "Don't even consider the before. Just focus on the after and see if he or she looks natural and appropriate for their age," suggests Dr. Jeffery Joseph, a board-certified facial plastic surgeon in Lafayette, Louisiana. Similarly, it's crucial to know how long after the surgery the after photo was taken. "Everyone looks fine one to two months later, when there's still some swelling that gives the impression of more volume," he notes. Ideally, look for photos that are six months or more post-operation.
All of the above being said, there are several obvious indicators that something went wrong during the surgery. Here, five warning signs that doctors say are most frequently seen in a failed facelift and what can be done to rectify them.
Noticeable Asymmetry
To be fair, all faces are slightly asymmetrical and will remain so even after facelift surgery. However, "noticeable asymmetry that can be clearly identified or uneven results from one side of the face to the other might suggest that the internal stitches were either not placed properly or not reinforced adequately," points out Dr. Diana Ponsky, a board-certified facial plastic surgeon in Beachwood, Ohio. Nerve damage, or neuropraxia, can also cause some asymmetry; but this then becomes a matter of whether it indicates a surgical complication or a flawed facial plastic surgery, she adds. Depending on the severity of the asymmetry, a revision or corrective facelift might be necessary, although sometimes injectable fillers can also be helpful, she notes.
Windswept Skin
In the current era, we have numerous tools and methods to address underlying tissue, meaning a facelift isn't merely about removing and pulling the skin, notes Dr. Ponsky, so there should be no excuse for ending up with overly taut, shiny, and very windswept-looking skin. (You know, the kind that was a clear sign in the past that someone had undergone a facelift; see: Mickey Rourke or Donatella Versace.) As for a solution, taking measures to enhance the skin's overall elasticity and plumpness is the best choice. Dr. Ponsky mentions that hyaluronic acid fillers can be effective in this regard, particularly the latest class of skin boosters, such as Skinvive.
An Irregular Hairline
"Hairline distortion is a significant giveaway," notes Dr. Joseph, adding that it's often observable along the temples and sideburns where incisions are made. There should be a natural transition and angle from the hair at the sideburn to where it meets the rest of the hairline, he remarks. This can actually be a more substantial issue in men who have had facelifts where surgeons end up almost completely removing the sideburns in an attempt to eliminate excess skin, notes Dr. Mofid. This creates a very odd appearance, and the sole solution is to undergo a hair transplant to essentially reconstruct the sideburns, he adds.
Earlobe Deformity
Given the location of incisions around the ear, this is another common area where things can go awry. Instead of the earlobe being loose and floppy, you might notice that it starts to pull downward, with the lobe attached to the rest of the skin, says Dr. Joseph. (It's often referred to as "pixie ear.") This indicates that too much skin was removed. Dr. Mofid concurs, noting that it can also be a sign that the dissection of the skin was carried out incorrectly. It is repairable, he adds, though it's likely to require another cosmetic or reconstructive surgery to obtain more skin to address this type of attachment.
Hypertrophic Scarring
"Plastic surgeons are evaluated based on the quality of their scars. Hypertrophic or raised scars are one of the most common reasons for a revisionary facelift," says Dr. Mofid. These can occur because the surgeon pulled the skin too tightly or removed too much skin initially. Dr. Ponsky adds that this also tends to happen in the area in front of the ears, where there is a general tendency for hypertrophic scarring because the skin is thicker. Solutions include steroid injections or injections of 5-FU, a drug used to treat hypertrophic scars and keloids. However, in extreme cases, the entire scar might have to be removed and redone, notes Dr. Mofid.
