Interval to Secondary Facelift: A Match-Cohort Analysis of Interval Time, Technique, and Complications

Facelift surgery remains the most commonly performed aesthetic procedure among patients over 65 years of age, with the number of both primary and secondary procedures increasing in both younger and older populations. Although primary facelift techniques and outcomes are well described, comprehensive analyses of secondary facelifts remain limited.

In a large matched retrospective cohort, we compare operative technique and safety between primary and secondary facelifts and assess interim timing as a proxy for longevity.

Primary and secondary facelift patients treated by a single surgeon (J.E.Z.) between January 2014 and January 2024 were retrospectively matched by demographic and medical characteristics. Operative technique, adjunctive procedures, operative time, and major (unplanned admission, reoperation, and persistent motor nerve injury) and minor (outpatient-managed) complications were analyzed. Interim time between procedures was assessed to examine the relationship between age at primary surgery and durability.

Ninety-seven patients were included in each cohort. Secondary facelifts were 44.3 min shorter than primary facelifts (P < .01) and more likely to be performed with Superficial muscular aponeurotic system (SMAS)-plication (P < .01). Complication rates did not differ. The mean interval between primary and secondary facelifts was 10.7 ± 4.9 years. Younger ages at primary facelift correlated with longer interim intervals between primary and secondary facelifts (r = -0.44, P < .01).

Secondary facelift surgery can be performed safely with complication rates comparable to primary procedures. An individualized operative strategy-employing sub-SMAS dissection when tissue quality permits and SMAS-plication when a more conservative approach is warranted-is supported. Younger age at primary surgery was associated with a significantly longer interval to secondary facelift.

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