Comparing the Safety and Efficacy of Superficial Musculoaponeurotic System and Deep Plane Facelift Techniques: A Systematic Review and Meta-analysis.

Abstract

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. The aim of the study was to compare complication rates and aesthetic outcomes of modern facelift techniques. 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. 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. 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.