Board Certified Plastic Surgeon, David P. Rapaport, MD, is one of the Manhattan, New York’s most sought after facelift surgeons. The best candidate for a facelift is a woman or man whose face and neck demonstrate skin laxity (sagginess), especially of the lower face/jowl area, and neck. Most patients who seek the NYC plastic surgeon’s expertise are in their forties to sixties, but facelifts can be performed successfully on people in their seventies or eighties as well, as long as they are in good health. In very selected cases, Dr. Rapaport will perform a facelift on women below the age of forty, if they have experienced significant facial aging, particularly as a result of sun exposure.
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Actual facelift patients of Dr. Rapaport.

Pre/Post Operative Instructions

About Facelifts

Unlike many plastic surgeons who perform their facelifts under general anesthesia with the patient completely unconscious and having a breathing tube for ventilation, Dr. Rapaport strongly prefers “twilight” anesthesia, also known as IV sedation. With this form of anesthesia, the patient is breathing on his/her own, responds to verbal commands (such as a request to take a deep breath), but typically has no memory whatsoever of the procedure. Not only does Dr. Rapaport consider this form of anesthesia to be safer than general anesthesia, but also recovery is much smoother and more rapid. Anesthesia is, of course, administered by Dr. Rapaport’s board certified anesthesiologist, Dr. John Grillo (or one of his associates), with whom Dr. Rapaport has worked for the past 10 years.

From a technical point of view, a facelift is the operation that addresses the core problems which have resulted from significant facial aging. While injectables can provide dramatic solutions for volume loss of the midface (areas around the cheeks and eyes), injectable fillers have a fairly limited role in addressing the jowls and neck. When the neck demonstrates significant crepy skin, as well as vertical bands or folds of skin (we call these platysmal bands, as they consist of edges of the platysmal muscle), there is very little that fillers or Botox can do. Patients with these problems are ideally treated by a facelift. Liposuction as well as direct reduction and contouring of neck fat is an intrinsic part of the facelift procedure and helps create a natural and rejuvenated appearing neck.

Facelifts vs. Mini Lifts vs. Lifestyle Lifts

With regard to terminology, Dr. Rapaport feels that there has been a veritable explosion of names for types of facelifts, and he regards these names as much more marketing and sales maneuvers than anything meaningful. Dr. Rapaport considers the words facelift, lower facelift, and neck lift to all refer to the same operation. The term “mini facelift” can be very misleading. According to Dr. Rapaport, there really should be no such thing as a true mini facelift. Once the surgeon is opening the face in order to rejuvenate it, he should, of course, perform every maneuver which is safe and reasonable to achieve optimal results. Some patients like to think of their facelifts as mini facelifts simply because they do not want to admit to themselves that they have had a facelift. A short scar facelift is a specific type of facelift, which refers to the facelift scar not extending far behind the ear and into the hairline or scalp. As noted above, however, the exact same type of operation is performed internally, and therefore a short scar facelift is truly not a mini facelift. Lifestyle Lift is a specific term used by a company for marketing, which does deserve some attention. Although the name Lifestyle Lift seems to denote a specific surgical technique, according to Dr. Rapaport, what it really denotes is a facelift performed under local anesthesia, which is marketed by a specific company. Dr. Rapaport feels strongly that while he prefers IV sedation to general anesthesia, some form of monitored sedation in the presence of an anesthesiologist is extremely important for the performance of a safe and optimal facelift procedure. When a facelift is performed under local anesthesia, the surgeon is under significant time pressure to work fast so that the patient does not become uncomfortable. Indeed, having a surgeon rush through the facelift procedure is not in the patient’s best interest. Furthermore, it stands to reason that the plastic surgeon performing a facelift is the key factor which determines the quality of the result. To the best of Dr. Rapaport’s knowledge, when a facelift is performed by the Lifestyle Lift people, the surgeon’s remuneration is quite secondary to the profits of the company at large. This may motivate them to cut costs wherever possible in order to achieve maximum profitability.

Midface Lifts

Midface lifts generally refer to facelifts which are performed via the lower eyelid and lift the soft tissues in an upward direction. These types of lifts are more commonly performed in the south than in the northeast, because they generally involve significantly more facial swelling and a prolonged recovery period. There also can be more issues with asymmetry using this technique. For these reasons, Dr. Rapaport does not perform facelifts via the lower eyelid approach.

Facelift Scars

Because facelifting involves removal of excess skin, they do require scars. These scars, however, can be very well hidden around the patient’s ears, and in women can be covered very well with a variety of hairstyles. People sometimes talk about the facelift scar being either “in front of” or “behind” the ear. This is another example where terminology can be very misleading. In fact, all common facelift techniques involve a scar in front of the ear. The “in front of” or “behind” terminology refer to whether the scar is in front of or behind the tragus.

Dr. Rapaport believes that selecting the scar location to be pre-tragal (in front of the tragus) or retro-tragal (behind the tragus), is a decision made on an individual basis. In many patients, there is a fine wrinkle immediately in front of the tragus, making the pre-tragal scar very appealing. Perhaps more importantly is the fact that the tragus is truly a part of the ear; it contains cartilage like the ear, and has a color and texture which match the ear much more than the cheek. When a scar is placed retro-tragally (behind the tragus), one is draping skin from the cheek onto what is really a part of the ear, and this can result in an unnatural appearance.

Dr. Rapaport’s Facelift Technique

In terms of the surgery itself, the Manhattan, New York Board Certified Plastic Surgeon employs techniques which minimize the risk of complications to skin and muscle. The surgeon emphasizes that facelift surgery is elective surgery which should not risk nerve, muscle, or skin damage.
As alluded to earlier, Dr. Rapaport takes a very individualized approach in planning and carrying out his facelift procedures. In general, Dr. Rapaport performs a two-layer lift, generally referred to as a SMAS facelift. The SMAS refers to the Superficial Musculo-Aponeurotic System. This is essentially the connective tissue which surrounds the muscles of the face and becomes lax over time. It is widely believed that addressing the SMAS at the time of the facelift produces both a more natural and longer lasting result. Dr. Rapaport may address the SMAS by moving it appropriately as a flap of tissue, or by performing what is called a SMASectomy, which involves the removal of the loosest portion of the SMAS. In either case, the skin is re-draped over the restored SMAS and closed with utmost care to produce the best scarring possible.

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Recovery

Dr. Rapaport sends his facelift patients home accompanied by a nurse hand-picked by our practice, who remains with the patient at least overnight. The morning after surgery, the nurse removes all bandages and any drains (if used), and forwards detailed photographs for the doctor to review. The presence of a nurse following facelift surgery is highly desirable both for comfort and well as for monitoring of blood pressure and to help allay any anxiety on the part of the patient and their family.

Complications

As with all surgery, there exists the possibility of complications. The most common complication following facelift surgery is hematoma. Hematoma refers to a collection of blood under the skin of the face and/or neck, which, depending on its size, may require intervention such as drainage, or re-operation. The literature reports the incidence of hematoma to be about 3% in female facelifts, higher in males because of the more vascular nature of men’s’ bearded skin. The incidence of this complication in Dr. Rapaport’s hands is significantly lower, likely a result of multiple factors, including careful technique and our insistence on nurse monitoring for the night after surgery. This keeps blood pressure under control. It is well established that increases in blood pressure lead to an increased risk of hematoma following facelift. It is therefore not surprising that having a trained nurse present for the highest risk period after surgery (90% of bleeding complications occur within 12 hours of surgery) will reduce the risk of this complication.
Skin loss, also called skin necrosis, can occur following facelift, particularly in the very thin skin between the back of the ear and the scalp. The risk of this problem is greatly reduced by having an experienced surgeon perform the surgery. Very small amounts of skin loss immediately behind the ear is not rare, and generally heals quickly and without incident. More extensive skin loss is rare in experienced hands. The risk of skin loss is greatly increased in smokers. It is for this reason that Dr. Rapaport absolutely insists that his patients who smoke totally refrain from all cigarette smoking for a minimum of 6 weeks prior to surgery, or he will not perform the surgery.
It is important to understand that numbness in the cheeks and neck is a guaranteed reality for several months following facelift. It is not a complication, because it will occur 100% of the time. The area of numbness will gradually shrink over time, and most patients will be left with very little numbness mainly just in front of their scars. Temporary numbness is universal because when the skin is elevated off the deeper tissues, the small nerve endings which supply sensation to this skin are also by necessity severed. As noted, these do grow back over time. Older patients will experience a longer period of numbness with less complete resolution compared with younger patients. Smokers can expect less improvement in numbness over time.
In contrast to numbness, which will occur to some extent in every facelift patient, motor nerve injury should be an exceedingly rare complication following facelift surgery. Indeed, Dr. Rapaport to date has not experienced a single case of motor nerve injury following facelift. His technique is intentionally one which avoids motor nerves. Operations such as deep plane facelifts, where the tissues are elevated at a level below the SMAS where the nerves to the muscles pass, has a much higher risk of temporary or even permanent motor nerve injury. If one experiences motor nerve weakness, such as a weakened smile on one side following facelift, this fortunately usually resolves fully over time. The most common cause of this problem, when it does occur, is collateral injury to nerves caused by electrocautery. Electrocautery is used to control bleeding.
Thick or wide scars are almost universally the result of poor surgical technique. Generally, the problem is closing wounds with too much tension. Dr. Rapaport takes great care to avoid this problem, and indeed skilled and experienced facelift surgeons can be expected to create very fine scars in almost all cases. At the time of consultation, Dr. Rapaport routinely reviews with his patients on an individual basis what type of scars they can expect.
Complications occurring as a result of anesthesia include airway problems and other possible complications such as blood clots (DVT-deep vein thrombosis leading to pulmonary embolus). Both these types of problems can be fatal and should therefore be of concern to any patient undergoing elective surgery with general anesthesia. Dr. Rapaport has been working with the same board certified anesthesiologist for about 10 years who employs a lighter form of anesthesia called conscious sedation, also referred to as “twilight” anesthesia. During this form of anesthesia, the patient is responding to verbal commands and breathing on their own. They general have no memory of the operation and recovery is rapid and smooth following surgery. Because the patient is not intubated and is relatively “light,” both airway problems and the risk of blood clots in the legs are virtually completely eliminated. Of course, Dr. Rapaport assesses each patient individually and obtains whatever outside medical input and clearance is indicated in each case.
Aside from safety concerns, the most common concern of facelift patients is that following surgery they will appear “different,” unnatural, have a wind-tunnel appearance, or have other signs of unnatural pulling. Patients can feel confident that these problems will not occur under Dr. Rapaport’s care. Patients are invited to look at his before and after results and decide for themselves.
While silicone breast implants offer the advantage of a potentially softer and more natural feel, there are disadvantages to take into account. Because the Silicone Breast implants come prefilled, they require a somewhat longer scar. While a scar under the breast is always an option, a scar on the border of the areolus is possible when the areolus is large enough. However, many patients prefer to have no scar on the breast at all. Dr. Rapaport has been performing underarm, endoscopic breast augmentation for 20 years, and has become a pioneer in endoscopic breast surgery. This technique, combined with Dr. Rapaport’s experience, has drawn patients locally, nationally and internationally to seek out Dr. Rapaport for silicone breast augmentation without breast scars.

Facelift Plastic Surgery Frequently Asked Questions

Your facelift surgery will be performed by Board Certified Plastic Surgeon, David P. Rapaport at his fully accredited Manhattan, New York out-patient facility. In very selected cases, the surgery may be performed at Manhattan Eye, Ear, and Throat Hospital or at Lenox Hill hospital.
Yes, in fact many of the Board Certified Plastic Surgeon’s facelift patients choose to have their facelifts performed in conjunction with other facial cosmetic surgery procedures, such as blepharoplasty (eyelid surgery), earlobe repair, or chin enhancement.
The length of the facelift surgery will depend on the individual. Typically, a facelift can be completed in less than three hours. However, the amount of work you will require will directly affect the amount of time the operation will take.
Yes, bandages may be applied to the head and neck with the purpose of providing mild compression to the area and preventing excessive motion. Your nurse will typically remove the bandages the day after surgery.
After a facelift, many patients are surprised by the lack of pain they experience after surgery. For several weeks, expect some swelling around the eyes; however, as the swelling goes away, you’ll begin to see the surgery’s progress. Bending or lifting can extend swelling and is not suggested for three weeks after surgery. Running, cycling, and aerobic exercise in general may resume after three weeks. Driving is permissible when the swelling goes down and does not get in the way of your vision. Flying is generally permitted approximately 10 days after surgery.
Yes and no. Obviously, facelifts do not stop the aging process, so that as time goes by, the facelifted face will show signs of aging, such as jowls and loosening skin. On the other hand, the person who has facelift surgery will always appear more youthful than they would if they hadn’t had the facelift surgery, even years later. The Board Certified Plastic Surgeon, David P. Rapaport, MD’ s favorite analogy is to imagine two identical twins needing a facelift. Only one decides to have facelift surgery, and they both return every year to been seen by the plastic surgeon. The patient who had facelift surgery will always appear younger than her “identical” twin, even when she feels she is ready for another one, 7-10 years after the first facelift.
If you have questions about facelift plastic surgery, or would like to schedule a consultation with the Board Certified Plastic Surgeon, please phone David P. Rapaport’s Manhattan, New York Plastic Surgery office at 212.249.9955 or email the NYC Plastic Surgeon at info@drrapaport.com