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.