title: The staged face lift:  addressing the biomechanical limitations of the primary rhytidectomy.
abstract: BACKGROUND
  Although early secondary face lift is a highly scrutinized procedure, it is beneficial for a select group of patients. Justification for performing the early secondary face lift or staged face lift is more apparent when considering the biomechanical limitations of the primary face lift.
  
  
  METHODS
  All patients undergoing primary face-lift procedures performed by the senior author (T.A.M.) between 1998 and 2008 were followed for 2 years to determine which patients would benefit from an early secondary rhytidectomy. Early secondary face lifts were performed in the same sub-superficial musculoaponeurotic system plane as the primary procedure and entailed full undermining.
  
  
  RESULTS
  Forty-seven of 742 patients (6.3 percent) undergoing a primary face-lift procedure underwent an early secondary rhytidectomy. Identified limiting factors of the primary face lift included suture-tearing force, viscoelastic properties (tissue creep and stress relaxation), blood supply, and an attempt to avoid an overly pulled appearance. Indications for early secondary rhytidectomy included early symptoms of recurrence or residual age-related changes in patients with severe preoperative laxity or poor soft-tissue elasticity and mainly involved the perioral region. There were no significant complications and there was high patient satisfaction in all cases.
  
  
  CONCLUSIONS
  With thorough understanding of the viscoelastic properties of facial tissues and proper consultation with patients, the early secondary face lift can be used as a safe and effective option with which to address the limitations of a primary face lift.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Chicago, Ill. From the Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University.
authors.forename: Vinay
authors.initials: V
authors.lastname: Rawlani
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Mustoe
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation; D000368:Aged; D001696:Biomechanical Phenomena; D005260:Female; D006801:Humans; D015187:Lipectomy; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D012086:Reoperation; D012189:Retrospective Studies; D015361:Rhytidoplasty / Q000379:methods*; D015595:Skin Aging