Extended Composite Approach to Deep Plane Face Lifting with Deep Contouring of the Neck and the Nuances of Secondary and Tertiary Facelifting. Principles for restoration of natural anatomy and aesthetically attractive face and neck contour.

Patients seek second facelifts either due to dissatisfaction with the primary procedure or years later after continued face and neck aging following successful first surgery. Previous surgical anatomical disruption, deformity of tension and vector, scar formation and skin excision compounded by the proliferation of historical energy based skin treatments, thread lift procedures and injectables makes revision rhytidectomy a complex process of causal identification and surgical repair. Patients seeking revision due to dissatisfaction with a primary procedure, or worse visible deformity, have a heightened sense of anxiety which necessitates accurate diagnosis, careful examination, comprehensive documentation and confidence in any planned secondary intervention as well as conservative expectation management. This article outlines the authors approach to identify the challenges posed and successfully perform secondary and revision rhytidectomy using a modified extended deep plane approach.