Overview
The best facelift technique remains debated. The authors prospectively enrolled 166 patients having a first facelift by a single surgeon between January 2019 and December 2024. Patients were allocated to deep plane or SMAS plication facelift, and the groups were compared on aesthetic outcome, satisfaction, recovery and complications.
Findings
- 166 patients: deep plane 45 (27.1%), SMAS plication 121 (72.9%).
- Median age 49 years (IQR 42.7-56); 95.2% female; 46% overweight.
- Baseline characteristics were comparable between groups.
- Rejuvenation rated excellent: 70.5% of SMAS cases vs 29.5% of deep plane cases (p = 0.67).
- Patient satisfaction was high in both groups (p = 0.09).
- Median recovery: 25.5 vs 30 days (p = 0.65).
- Overall complications: 21.6% vs 28.7% (p = 0.39).
- Transient facial nerve weakness: 11.1% vs 12.4% (p = 0.70).
- Ancillary procedures: 93.3% vs 95.9% (p = 0.79).
- Logistic regression found no significant predictors of outcome or interaction effects.
- Level of evidence: II.
What it means for a patient
- In the first months after surgery, deep plane and SMAS plication facelifts gave similar results, satisfaction, recovery and complication rates in this surgeon's hands.
- Temporary facial nerve weakness occurred in about 1 in 9 patients in both groups.
- The authors state results depend more on surgical expertise and patient selection than on technique alone.
- Limits: median follow-up of three months, unequal group sizes, one surgeon, and no validated outcome instruments.
Why this paper matters
It is a prospective comparison of two facelift techniques from one surgeon, finding no significant early differences. It does not address long-term results.
Terms
- Deep plane facelift: a facelift that lifts the skin and the deeper SMAS layer together as one flap.
- SMAS plication: folding and stitching the SMAS layer to tighten it without cutting beneath it.
- SMAS: the superficial musculoaponeurotic system, a fibrous and muscle layer under the facial fat.
- Prospective cohort study: a study that enrolls patients before treatment and follows them forward.
- IQR (interquartile range): the range covering the middle half of values.
- Ancillary procedures: extra procedures done with the facelift.
- Logistic regression: a statistical method that tests which factors predict an outcome.