title: A 20-year experience with secondary rhytidectomy: a review of technique, longevity, and outcomes.
abstract: BACKGROUND
  The increasingly more common secondary rhytidectomy patient presents with recurrent soft-tissue descent and stigmata of primary face lift, which can require techniques unique to secondary rhytidectomy. The senior author's (R.J.R.) experience with secondary rhytidectomy is reviewed, focusing on surgical technique, longevity, and outcomes.
  
  
  METHODS
  Data collected after chart review of a 20-year study period included face-lift technique; duration between primary, secondary, and tertiary face lifts; concurrent procedures; and complications (i.e., hematoma, seroma, nerve injury, skin slough, infection, and need for revision). Surgical technique focuses on the "five Rs" of secondary rhytidectomy: (1) resect skin/scar, (2) release of abnormal superficial musculoaponeurotic system (SMAS) vectors, (3) refill by means of fat grafting, (4) reshape with SMASectomy or SMAS-stacking plication, and (5) redrape skin. The longevity of primary and secondary procedures was compared.
  
  
  RESULTS
  A total of 811 face lifts were performed during the study period; 60 were secondary procedures. Ten secondary patients went on to have a tertiary face lift. Average duration between primary and secondary face lift was 9.0 years, and that between secondary and tertiary procedures was 7.5 years, showing no difference in longevity (p = 0.2). Complications included one each of seroma, skin slough, and temporary marginal mandibular nerve injury (2 percent). Necessary revisions included one neck, one earlobe, and one preauricular scar.
  
  
  CONCLUSIONS
  Secondary rhytidectomy has complications similar to those of a primary procedure, and most patients have a second operation a decade later. Adherence to the five Rs of secondary rhytidectomy will enable the plastic surgeon to safely restore youth and correct stigmata of primary face lift.
authors.affiliation: Dallas, Texas From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
authors.forename: Evan W
authors.initials: EW
authors.lastname: Beale
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Rasko
authors.forename: Rod J
authors.initials: RJ
authors.lastname: Rohrich
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D015361:Rhytidoplasty / Q000379:methods*; D013997:Time Factors