Comparing the Safety and Efficacy of Superficial Musculoaponeurotic System and Deep Plane Facelift Techniques: A Systematic Review and Meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of mixed study designs (RCTs, cohort studies, and case series)
PubMed 40600822 · doi:10.1097/SAP.0000000000004454
What was done
A systematic review and random-effects meta-analysis searched MEDLINE, Embase, Cochrane Library, CINAHL, and LILACS up to May 2024 to compare superficial musculoaponeurotic system (SMAS) and deep plane facelift techniques. Eligible designs included randomized controlled trials, cohort studies, and case series (>10 patients) reporting complication rates, aesthetic results, or patient satisfaction.
What was found
Across 47 studies including 10,766 patients: - 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 were temporary and resolved over time, with permanent nerve injury being rare. - Aesthetic outcomes showed significant improvements with both techniques; only one study directly compared them, reporting superior midface rejuvenation with deep technique facelifts.
Why it matters
This review demonstrates that SMAS and deep plane facelifts carry comparable safety profiles with low rates of permanent nerve damage. However, current literature lacks sufficient direct comparative evidence to firmly establish aesthetic superiority of either technique.
Limits
The synthesis included mostly non-randomized cohort studies and case series, introducing potential confounding and heterogeneity. Only one study provided a direct head-to-head comparison of aesthetic outcomes. Relative risk estimates, confidence intervals, and statistical tests for subgroup differences were not reported in the abstract.
Cited by
- supports No studies have demonstrated that deep plane facelifts produce better scarring outcomes than SMAS facelifts.
- contradicts Deep plane facelifts carry a significantly higher risk of facial nerve injury compared to SMAS facelifts.