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Comparing the Safety and Efficacy of Superficial Musculoaponeurotic System and Deep Plane Facelift Techniques

Vayalapra, Sushanth; Guerero, Daniel N.; Sandhu, Vinesh; Happy, Armand AK; Imantalab, Delaram; Kissoonsingh, Priyanka; Khajuria, Ankur

Authors

Sushanth Vayalapra

Daniel N. Guerero

Vinesh Sandhu

Armand AK Happy

Delaram Imantalab

Priyanka Kissoonsingh

Ankur Khajuria



Abstract

Background Facelift surgery (rhytidectomy) addresses skin laxity, soft tissue descent, and volume loss, with techniques such as the superficial musculoaponeurotic system (SMAS) and deep plane facelifts offering distinct advantages. However, the optimal technique remains debated due to differences in complication rates and aesthetic outcomes. Objective The aim of the study was to compare complication rates and aesthetic outcomes of modern facelift techniques. Methods A systematic search of databases, including MEDLINE, Embase, Cochrane Library, CINAHL, and LILACS, was conducted up to May 2024. Eligible studies reported on SMAS or deep technique facelifts with outcomes such as complication rates, aesthetic results, and patient satisfaction. Studies included randomized controlled trials, cohort studies, and case series with more than 10 patients. A random-effects meta-analysis was used to pool complication rates. Results A total of 47 studies involving 10,766 patients were included. Hematoma rates were 3% for deep technique facelifts and 2% for SMAS facelifts. Infection rates were low for both techniques. Nerve injury rates were similar between groups; most reported nerve injuries were temporary and resolved over time, while permanent nerve injury was rare. Aesthetic outcomes showed significant improvements with both techniques; however, only one study directly compared them, finding superior midface rejuvenation with deep technique facelifts. Conclusions Both SMAS and deep techniques demonstrate comparable safety profiles, although limited comparative data and heterogeneous outcome measures preclude definitive conclusions about relative efficacy. While some evidence suggests potential advantages of deep approaches in midface rejuvenation, technique selection should be individualized. Future research requires standardized outcome measures and prospective comparative studies.

Citation

Vayalapra, S., Guerero, D. N., Sandhu, V., Happy, A. A., Imantalab, D., Kissoonsingh, P., & Khajuria, A. (2025). Comparing the Safety and Efficacy of Superficial Musculoaponeurotic System and Deep Plane Facelift Techniques. Annals of Plastic Surgery, 95(1), Article 10.1097. https://doi.org/10.1097/sap.0000000000004454

Journal Article Type Review
Acceptance Date Jul 15, 2025
Online Publication Date Jul 15, 2025
Publication Date 2025-07
Deposit Date Jul 16, 2025
Journal Annals of Plastic Surgery
Print ISSN 0148-7043
Electronic ISSN 1536-3708
Publisher Lippincott, Williams & Wilkins
Peer Reviewed Peer Reviewed
Volume 95
Issue 1
Article Number 10.1097
DOI https://doi.org/10.1097/sap.0000000000004454
Public URL https://keele-repository.worktribe.com/output/1321975

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