Challenges and complications in secondary rhytidectomies, a systematic review.

Background: The demand for secondary rhytidectomies is increasing. These procedures are technically more demanding than primary surgery due to postsurgical anatomical changes, presenting unique challenges and risks. The objective of this systematic review is to define these challenges, describe common surgical principles, and summarize the reported outcomes and complications of secondary rhytidectomies. Methods: A literature search was conducted on PubMed and Scopus using particular keywords. Inclusion criteria included randomized controlled trials, observational studies, comparative studies, case series and case reports that reported the surgical outcomes of secondary rhytidectomies. Results: Fourteen articles were included in this systematic review, encompassing 737 patients. Presentation was approximately 9-12 years after primary surgery. The most consistent intraoperative finding was altered anatomy, including a thinner, more delicate superficial musculoaponeurotic system (SMAS), fibrosis, and scarred tissue planes. Reported complication rates in cohort studies ranged from 2.0 % to 21.1 %. The most common complications were hematoma and temporary facial nerve injury, with rates of the latter reaching as high as 11.9 % in some series. Other reported adverse events included seroma, minor skin slough, and delayed healing. Conclusions: A secondary rhytidectomy presents distinct intraoperative challenges stemming from altered anatomy. Despite this increased complexity, the existing literature suggests that overall complication rates are comparable to those of primary facelifts.