Overview
Deeper facelift techniques, such as platysma flaps, dissection under the platysma and SMAS dissection, increase the risk of injury to the facial nerve branches. The authors review the anatomy of the facial nerve's muscle branches. They describe how to prevent injury during facelift and how to manage an injury when one occurs.
Findings
- Facial nerve injury in facelift had been occurring in less than 1% of cases.
- More than 80% of these injuries recovered function on their own within 6 months.
- Newer techniques (platysma and subplatysmal flaps, SMAS dissection) increase the risk of nerve branch injury.
- An increase in reported nerve injuries had not yet appeared.
- The authors note these techniques were recent and usually done by more experienced surgeons, more slowly, under direct vision and with more careful dissection.
- More care is needed to prevent injuries.
- The paper covers the detailed anatomy of the muscular branches of the facial nerve, prevention, and management.
What it means for a patient
- Injury to a facial nerve branch during facelift was uncommon in this report, under 1%.
- Most injuries recovered on their own within 6 months.
- Deeper facelift techniques carry more risk to the nerve branches. Ask your surgeon how often they perform deep facelifts and how they protect the nerve.
- The abstract does not say how many patients the injury and recovery rates are based on.
Why this paper matters
It set out facial nerve injury rates and recovery in facelift and warned that deeper techniques raise the risk to nerve branches. It focuses on anatomy, prevention and management. Cited 202 times (NIH iCite, 2026-09-25).
Terms
- Facial nerve: the nerve that moves the muscles of facial expression.
- Rhytidectomy: the medical name for a facelift.
- SMAS: the layer of muscle and fibrous tissue under the facial skin and fat.
- Platysma: the thin muscle over the neck and lower face.
- Subplatysmal flap: tissue lifted from beneath the platysma muscle.
- Spontaneous return of function: nerve recovery without further treatment.
- Direct vision: operating while the surgeon can see the structures, rather than working blind.