Op. Dr. Mehmet Cömert is a plastic, reconstructive and aesthetic surgeon in Istanbul, European Board certified (FEBOPRAS) and in practice since 2009; in 2023 he trained on Bryan Mendelson's deep plane course at the Mayo Clinic. Many of the facelift patients who write to him have already had a facelift somewhere else.

The answers below are his, drawn from the voice notes and messages he records when assessing revision cases. Names, dates and anything identifying have been removed, and individual cases have been turned into patterns. Where a decision depends on seeing a face in person, he says so.

Key takeaways

  • Ears, scars, operation notes and a skin-pinch video are the first things he checks in a facelift done elsewhere.
  • Mini, skin-only and piecemeal lifts disappoint because the tension sits in the skin and unnatural vectors develop.
  • A revision is a full deep plane facelift with temples and neck, re-setting the vectors, not a touch-up.
  • He waits about a year after the previous facelift so that swelling, the early lifted look and any temporary nerve weakness have settled.
  • Scars, earlobes and neglected necks improve well; persistent neck bands and perfect symmetry cannot be promised.

What do you look at first when a patient comes to you after a facelift done elsewhere?

In brief: The ears and the scars, the operation notes, and a skin-pinch video in front of the ears. Together they tell me whether this is a revision, what was done underneath, and how much skin I have to work with.

The first thing I look at is the ears and the scars around them. Not every patient clearly says they had a facelift, but when I look at the photos I can see incision lines and an increase in vascularity in front of the ears, and that already tells me this is a revision. I look at whether the earlobes are pulled or attached, where the scars sit, and at the lower lids and the eye shape, because a previous blepharoplasty or canthoplasty changes the plan.

The second thing is the history. I want to know what type of facelift it was, where it was done, when and by whom, and I ask for the operation notes if they exist; knowing which technique was used is really good information on my side. Photos from before that operation are very good for us.

The third is a short video of the patient pinching the skin in front of the ears. It shows me how much skin excess there is, and that decides whether I revise with an open deep plane facelift and reposition the scars, or whether an endoscopic style of deep plane lift is the better route.

Before and after photographs of a 64-year-old patient from the United States eight months after a revision deep plane facelift with deep neck lift, endoscopic forehead lift, upper and lower blepharoplasty, fat grafting and lip lift
A revision case: a 64-year-old patient from the United States, eight months after a revision deep plane facelift combined with deep neck lift, forehead lift, eyelid surgery, fat grafting and a lip lift. Individual results vary.

Why do first facelifts disappoint? The reasons patients ask me for a facelift revision

In brief: One pattern: the first lift put too much tension on the skin at the incisions, earlobes dragged down, scars in front of the hairline. Another: piecemeal work, one area lifted and the rest left behind. And scars that simply sit badly.

The first pattern is the mini lift, or the skin-only lift. A patient in her thirties or forties has a mini lift and later notices the incision line in front of the hairline, an earlobe that is attached and pulled, and a face that no longer moves quite freely. I don't believe in these lifts: they put too much tension on the skin at the incision lines, and that causes these problems. I explain the difference in deep plane versus SMAS facelift.

These fake, unnatural vectors can create a little bit of bulging, unnaturalness, and movement restrictions on your face.

The second pattern is piecemeal work: a temporal-style lift with a partial neck lift, a lower facelift on its own, or lower lid bags removed while the mid face was never lifted, so hollowness and lower lid rounding came later. When one area is pulled and the neighbouring area is left where it was, unnatural vectors can develop. That is why I do not like neck-only touch-ups and usually revise everything together.

The third group is scars: visible incision lines near the ears, scars behind the ears and in the scalp. Those are among the better reasons to revise, because after a revision the scars will be much better placed and much prettier.

What can a revision facelift fix well, and what can it never fully undo?

In brief: Scars, pulled earlobes, wrong vectors, a neglected neck and a retracted lower lid: these I can usually improve a lot. Persistent neck bands, marionette lines and perfect symmetry I can improve but not erase, and I say so beforehand.

Scars can be repositioned and made much prettier. Pulled or attached earlobes can be released and reconstructed. Wrong vectors can be released and re-set, and permanent sutures causing a reaction behind the ears can be cleared out. A neck that was left alone or only partly treated can be contoured with a deep neck lift, and a lower lid that retracted after an earlier blepharoplasty can be supported with a canthoplasty and a mid-face lift.

Platysmal bands are very persistent; I can make sure they come back as late as possible, but they can come back. Marionette lines can improve, but we cannot know in advance by how much. Symmetry can be tried, but we all have asymmetries and I don't play the symmetry game.

No surgery can ever be guaranteed to make your problems go away completely.

Where do I say no, or not yet? When someone asks for a small fix that leaves the rest behind, a neck-only revision or reversing a canthoplasty. When a patient still smokes and will not stop in time. When there is too much fatty weight for a long surgery. With diabetes, until I have seen a recent HbA1c, and with hypertension I want to know how it is faring. When the previous surgery is too fresh. And when expectations are not realistic or the patient is indecisive.

What changes technically in a second facelift when the face has already been lifted?

In brief: I go in open, explore what was done, release the old vectors and re-vector the deep layer. Altered tissue planes, altered blood supply and sticky planes from energy devices make the dissection more careful, and the plan is a full lift, not a patch.

A revision is an open approach with the deep plane facelift, where we go in and explore what's going on, including whether there are permanent sutures to clear out. I routinely use the deep plane method to revise SMAS lifts, and mini lifts and skin-only lifts get the same answer: releasing the vectors, re-vectoring them, and creating more natural-looking vectors.

The blood supply to the skin and the tissue planes were altered by the previous operation, which modestly raises the risk of slow healing, most often behind the ears, and that risk is meaningfully higher in smokers. Energy-based treatments such as HIFU can be a bigger problem than the previous surgery itself: they make the planes sticky, and sticky planes are hard to dissect and make it hard to preserve the nerves that move the face. Threads, likewise, are more of a problem than an old facelift.

If the old incisions healed well I can use them; if they sit badly I move them, and the earlobe is released and the skin advanced so the tension comes off it. A temple or brow lift comes with it, because lifting the mid face creates bunching at the temple, and a mid-face lift is added because the deep plane lifts semi-vertically.

How soon after a facelift can you have a revision? How do you decide a face is ready?

In brief: I want about a year to pass after the previous facelift before I operate again. Swelling, the early lifted look and temporary nerve weakness all need to settle first; until then I would rather send you back to your own surgeon.

When someone writes to me a few months after a lift done elsewhere, my honest answer is that a procedure before one year has passed is not appropriate, and that she should speak with her own doctor first. Once a year has passed, it is a suitable time to redo it. For my own patients, our policy is that touch-ups for aesthetic preference are generally considered after nine to twelve months, allowing full healing and the natural resolution of swelling; a true complication is different and is treated as part of our care.

What am I waiting to see settle? Swelling first: neck contour and asymmetry are judged late, once the swelling is gone, and asymmetric swelling during healing is not the same as a permanently asymmetric result. The early lifted look of the brows and cheeks softens over the first weeks and months. Neuropraxia, temporary nerve or muscle problems, which we usually see more with revisional cases, heals by itself; I have never seen it last longer than three months.

Readiness is not only about the face: the gates I listed earlier still apply. If a filler complication has damaged the tissue, I treat that first with stem-cell-rich fat grafting, reassess, and plan the facelift as a possible second stage. And it is more correct to decide at the examination.

Before and after photographs of a 49-year-old patient from the United States two months after a revision deep plane facelift with deep neck lift, endoscopic forehead lift, blepharoplasty and fat grafting
A second revision pattern: a 49-year-old patient from the United States, two months after a revision deep plane facelift with deep neck lift, forehead lift, eyelid surgery and fat grafting. Early healing, not a final result.

What do patients unhappy with a facelift fear most, and what do you actually tell them?

In brief: They fear looking done again, losing themselves, nerve damage, and trusting the wrong person twice. I tell them a revision restores, it does not change the face, that the early lifted look softens, and that improvement is real but its amount cannot be promised.

One fear I hear is "I want to look younger but still like myself". Others: the incisions in front of the ear, the temple lift, nerve damage, and "I need a doctor I can trust".

These procedures in general won't change your face; they would just restore youthfulness.

That is what I tell them, and I add: all within natural limits, not like the last time. Early on the brows and cheeks sit slightly higher and can look a little done, then every week it gets better. On nerves: neuropraxia, temporary nerve or muscle problems, is a risk we usually see more with revisional cases or with patients who have an excessive amount of filler or have done a lot of energy-based treatments; they heal by themselves, and time is the primary thing.

People also ask whether fat grafting alone or a neck-only touch-up can fix a previous lift. I would probably not recommend that: a revision is a full facelift, with the temples, the neck and often the lower lids, and it means another recovery process. Things take time to improve; our reviews show how patients describe that.

Is there one revision facelift case that stayed with you?

In brief: A woman who had a temporal-style lift and a partial neck lift elsewhere, and eyes that looked smaller after a canthoplasty. She asked me to reverse the canthoplasty. The lesson was to stop chasing single features and re-set the whole face.

A woman came to me after a temporal-style facelift and a partial neck lift done elsewhere: pulled earlobes, a reaction to what were probably permanent sutures behind the ears, scars in the scalp, and eyes that looked smaller after a canthoplasty. Her question was specific: could I reverse the canthoplasty?

I did not think that was a very good idea. The only real option was a revisional full facelift: an open deep plane approach where we go in and explore, re-vector the tissues, clear out the permanent sutures, release the earlobes and advance the skin so the tension comes off them, restore the brow position, add a lower blepharoplasty, and revise the scalp scars when we revise the temporal area. The eyes I could only judge in person: if an excessive canthoplasty was the reason it could be released, but not on the strength of a photo.

It ended with a request for her operation notes and a plan for the whole face rather than a patch. What I carry from her: a revision is not about the one feature the patient points at; it is about the whole face, and the final decision belongs to the examination.

I'm unhappy with a facelift I had abroad or at home. What should I know before booking a revision in Istanbul?

In brief: Don't book on emotion. Wait until about a year has passed, talk to your original surgeon, gather your operation notes and old photos, tell me everything that was ever done to your face, and make sure you can stay for the follow-ups.

First, slow down. If your facelift is only a few months old, speak with your own surgeon and let about a year pass before anyone operates again. If you are indecisive, think more; on a short schedule, this is not a surgery to squeeze in.

Second, help me see what I'm dealing with. Send photos, a video of your concerns, the skin-pinch video, your operation notes and photos from before the surgery. Then tell me everything else: fillers, threads, HIFU or other energy-based treatments, lasers, hormone therapy, blood pressure, diabetes, smoking. None of it is an automatic no, but each changes the plan: fillers, for example, are checked under ultrasound and dissolved first.

Third, understand what you are booking. A revision is quoted as its own case; see our cost page. It is a long trip and an intense recovery, worth it only if your expectations are realistic. You are expected to stay as long as we advise and attend the follow-ups: leaving earlier than advised may limit or void revision benefits, and sometimes a patient is asked to stay longer for medical safety. If you like what I say and how my team responds, it could be a good idea for us to meet.

The next step

If you are unhappy with a facelift, send me your photos, videos and operation notes through our free online assessment. I look at these cases myself, and I will tell you honestly whether it is a yes, a not yet, or a no.

About these answers. They are edited from Dr. Cömert's own consultations and the voice notes he records for patients, condensed for reading. Every case is described as a pattern; no individual patient is identifiable. Nothing here replaces an assessment of your own photographs and history.