title: Secondary rhytidectomy:  comprehensive review and current concepts.
abstract: BACKGROUND
  Secondary rhytidectomy procedures present an additional level of complexity in comparison with primary procedures. Patients may seek secondary rhytidectomy, in part, as a result of complications stemming from the initial procedure, because of the natural process of aging, or a combination of the two. The aim of this literature review was to examine the difference in patient characteristics, techniques, and challenges specific to secondary face lifts.
  
  
  METHODS
  A literature search was performed on secondary face-lift procedures using MEDLINE, PubMed, and Cochrane databases. Using the keywords "facelift," "face lift," "rhytidoplasty," and "rhytidectomy" combined with "secondary," "reoperation," "revision," and "multiple," an initial search was performed. Then, all abstracts were evaluated for relevance.
  
  
  RESULTS
  The search yielded 291 articles with these key terms. The articles were reviewed for relevance and, in total, 13 were identified specific to secondary rhytidectomy procedures. Six were retrospective studies and the rest were expert special topic articles.
  
  
  CONCLUSIONS
  Although there are limited data specific to secondary rhytidectomy procedures, several important principles were evident from these retrospective reviews and editorial articles. It is important to assess whether the patient is exhibiting stigmata of the primary rhytidectomy procedure or natural signs of aging, such as volumetric deflation and recurring ptosis of previously lifted tissues. Accurate and systematic preoperative analysis is key for successful planning and execution of secondary rhytidectomy procedures.
authors.affiliation: Dallas, Texas From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
authors.forename: Yvonne M
authors.initials: YM
authors.lastname: Rasko
authors.forename: Evan
authors.initials: E
authors.lastname: Beale
authors.forename: Rod J
authors.initials: RJ
authors.lastname: Rohrich
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications; D011300:Preoperative Care; D012086:Reoperation; D015361:Rhytidoplasty / Q000379:methods*; D015595:Skin Aging