Facelift Surgery Following Superficial Parotidectomy: Is it Safe?

Introduction: Patients who have previously undergone superficial parotidectomy may also seek facelift surgery for facial aging and rejuvenation. These patients present unique challenges compared to a standard facelift patient. Most concerning is the location of facial nerve branches, which may be superficial and displaced. In addition, significant contour deformities and abnormal scar patterns may be present. The purpose of the study is to review our series of patients and assess potential morbidity and safety of facelift surgery in superficial parotidectomy patients. Methods: A retrospective case series was performed reviewing all patients who underwent facelift surgery following superficial parotidectomy from 2000 to 2017. Data were collected for: postoperative facial nerve deficit, soft tissue contour and scar deformities, facelift technique, ancillary soft tissue augmentation procedures and pre- and postoperative photographs. An evidence-based treatment algorithm to address specific problems in this patient population was developed. Results: A total of seven patients were identified who underwent facelift surgery following parotidectomy. Patients underwent one of the standard SMAS procedure on the non-parotidectomy side, and surgical modifications were made to address the parotidectomy side; soft tissue augmentation was performed in two patients. Precautions to identify the facial nerve and prevent injury, including nerve monitoring and stimulation, were utilized in all seven patients. No permanent postoperative facial nerve injury was noted. Conclusion: Facelift following superficial parotidectomy was safely performed in all cases. Special consideration should be given to contour deformities, facial nerve location and scar placement. However, if approached properly, these patients can still be considered as suitable candidates for facelift surgery. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.