Rhytidectomy After Parotidectomy

A history of prior parotidectomy is typically thought to substantially increase the risk of facial nerve injury for patients undergoing subsequent facelift surgery. For this reason, surgeons are often hesitant and may even elect not to perform facelift surgery on such patients. However, we have developed a safe and predictable operation for performing the post-parotidectomy rhytidectomy. Here, we present our rationale, approach, and results for performing this operation. This review is a retrospective case series. In total, 1200 facelifts from 2012 to 2016 performed by a single surgeon (D.B.R.) were reviewed. From these, 9 patients were identified as having had parotid surgery prior to rhytidectomy. Rhytidectomy was performed in 8 of 9 cases with a deep-plane, bilaminar approach. There were no intraoperative complications. One patient had a direct neck lift. There were no cases of revision. There were no cases of facial nerve damage including paresis or paralysis; 100% patient satisfaction was noted. Rhytidectomy with a deep-plane approach may be performed safely in patients who have undergone prior parotidectomy. Although there were no complications, revisions, postoperative asymmetry, or dissatisfaction in the patients in this study, it must be stressed that there is no substitute for a thorough appreciation of the surgical anatomy in combination with consideration of the changes to the surgical field that occur with parotid surgery.