FACE CONTOURING

REVISION

An unsatisfactory contour can come from several sources: bone that was not reduced enough or was reduced too much, a visible step where the cut stopped, bone that did not heal together, side-to-side differences, or skin and muscle that dropped after the bone support was removed. We compare your current exam and CT scan with your original preoperative images and operative records to separate what is bone from what is soft tissue or swelling.

A 3-D CT scan is the clearest way to see whether the bone healed in the intended position and whether a contour issue is coming from the skeleton or from the soft tissue draped over it. Muscle bulk, fat, swelling, and loose skin can mimic or hide a bone problem. We use imaging plus a hands-on examination to assign each concern to the right tissue layer so the revision targets the actual source of the problem.

You should generally wait at least 6 to 12 months for the bone and soft tissue to fully heal and for residual swelling to resolve. Planning revision too early risks operating on a face that is still settling. We track your healing at follow-up visits and schedule revision imaging only once your contours are stable enough to make a reliable plan.

A remaining prominence can sometimes be conservatively reduced, but revision dissection works through scar tissue and near nerves that may have shifted position, so the margin for aggressive bone removal is narrower. The risk of nerve injury and sagging is higher in revision compared to primary surgery. We evaluate whether the remaining width is enough of a concern to justify those increased risks.

Over-resection is harder to fix than under-resection. Reconstruction options include a bone graft from your own body, a custom implant designed from your CT scan, fat grafting to add volume, or a lifting procedure to reposition soft tissue that has dropped. Each has different risks and degrees of predictability. Your surgeon walks through which combination best suits your bone loss pattern and soft-tissue quality.

Yes, hardware that is causing discomfort or is visible can usually be removed or repositioned during a revision. The bone around the hardware needs to be fully healed before removal makes sense. We discuss whether hardware is the source of your concern and what the recovery from removal alone would involve.

Scar tissue from the first surgery makes tissue planes harder to separate, increases bleeding, and can obscure the landmarks the surgeon uses to identify nerves and blood vessels. Recovery swelling and mouth-opening limitation may last longer after revision than after the primary surgery. We factor this in when planning the revision and may stage the work across more than one operation for safety.

Yes, nerves that were stretched or displaced during the first surgery are more vulnerable during a second dissection through scar tissue. If you already have numbness from the first operation, the risk of making it worse or creating a new motor weakness is higher. Your surgeon checks your current sensory and motor status before planning revision and discusses whether the benefit justifies the added nerve risk.

Generally yes, because the tissues have already been operated on and scarred, swelling and restricted mouth opening tend to last longer after revision. The recovery timeline is extended and less predictable than a first surgery. We give you a realistic estimate based on what is being done and what the tissue condition is at the time of the revision.

Yes, if the bone position is acceptable and the main concern is soft tissue that has dropped after bone support was removed, a lifting procedure or fat grafting can restore volume and elevation without touching the bone again. This is often a lower-risk step than a second bone revision. Your surgeon checks whether the sagging is from tissue looseness or from an underlying bone shape that still needs correction.

The goal is a safer, smoother balance rather than perfect mirror symmetry, because the two sides started the revision with different bone loss and scar patterns. Aggressive correction of one side to match the other often creates more problems than it solves. We talk frankly about what is achievable and may recommend staging the revision if two separate problems need different solutions.

Complex revisions sometimes require more than one stage because fixing every issue in a single surgery can be too aggressive for the tissue and nerves to tolerate. A staged approach may be safer, with a second fine-tuning procedure after the first has healed. We set the expectation that a single operation may not be the final word, and we plan the sequence with your safety and the result in mind.