Figure 3 - available via license: Creative Commons Attribution 4.0 International
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Depiction of various facelift techniques, with top left panel illustration of the lateral SMAS technique as seen by the lateral incision made here; top right panel illustration of the high SMASectomy technique, with the incision modified to allow for SMAS elevation; bottom left panel demonstrating the SMAS plication technique often used in thinner faces; and the SMASectomy technique incision modified for heavy faces. SMAS, superficial musculoaponeurotic system.
Source publication
Background
Facelift continues to be one of the most common aesthetic procedures performed in the United States. Although there exist many techniques and variations, superficial musculoaponeurotic system (SMAS) manipulation, by way of plication, overlap, or SMASectomy, is common and has been shown to result in favorable cosmesis and durability. Howe...
Citations
Background
Facelift procedures are a popular method of facial rejuvenation. The most common technique is superficial muscular aponeurotic system (SMAS) plication, with several variations. However, the optimal approach remains unclear. This review analyzed previous studies to compare SMAS facelift techniques, their outcomes, and complication rates.
Methods
A systematic search was conducted using the MEDLINE, Cochrane, Embase, and Google Scholar electronic databases in September 2022. The search included studies published from January 2000 to September 2022 using keywords such as “facelift,” “complications,” and “outcomes.”
Results
This review examined 27 selected studies that evaluated six SMAS facelift techniques. The studies involved 6086 patients in total, over 85% of whom were satisfied with the outcome of their surgery. The complication rates varied depending on the technique used, with the SMAS flap and composite SMAS technique having the highest (5.75%) and lowest (0.05%) complication rates, respectively. The most common complications were temporary facial nerve injury (0.85%) and skin necrosis (0.41%). To date, only one case of permanent facial nerve injury has been reported.
Conclusions
Based on our findings, SMAS facelift techniques achieve high patient satisfaction rates, with complication rates that vary by technique. The composite SMAS technique showed the lowest complication rates, whereas the SMAS flap showed the highest rate. However, some studies have not reported all complications, making it difficult to determine the best approach. Therefore, future studies are required to identify the most aesthetically pleasing technique with the lowest complication risk.
