A Meta-Analysis of Complication Rates Among Different SMAS Facelift Techniques.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of non-randomized observational cohorts and surgical case series
PubMed 30768122 · doi:10.1093/asj/sjz045
What was done
A systematic review and meta-analysis adhering to PRISMA guidelines evaluated complication rates across different superficial musculo-aponeurotic system (SMAS) rhytidectomy techniques. Studies were categorized into six surgical approaches: SMAS plication, SMASectomy/imbrication, SMAS flap, high lateral SMAS flap, deep plane, and composite rhytidectomy. Postoperative complications were compared across techniques.
What was found
Across 183 included studies: - Temporary facial nerve injury was highest in high lateral SMAS (1.85%) and composite rhytidectomy (1.52%), both significantly higher than SMAS plication (odds ratio [OR] = 2.71 and OR = 2.22, respectively; P < 0.05). - Risk of permanent facial nerve injury did not differ significantly among techniques. - Major hematoma rates were increased in deep plane (1.22%, OR = 1.67, P < 0.05) and SMAS imbrication (1.92%, OR = 2.65, P < 0.01). - Skin necrosis was higher with the SMAS flap technique (1.57%, OR = 2.29, P < 0.01). - Significant differences were reported for seroma and infection, but specific rates were not provided in the abstract.
Why it matters
Surgeons often avoid deeper sub-SMAS dissections due to concern for facial nerve damage. This meta-analysis shows that while deeper techniques have higher rates of temporary nerve injury and specific local complications, the risk of permanent nerve damage does not differ by technique.
Limits
The total number of patients, demographic details, and length of follow-up were not reported in the abstract. The primary literature largely consists of retrospective observational studies and case series with potential variability in complication definitions, reporting rigor, and surgeon experience.
Cited by
- contradicts Deep plane facelifts carry a significantly higher risk of facial nerve injury compared to SMAS facelifts.