Evolution of Superficial Muscular Aponeurotic System Facelift Techniques: A Comprehensive Systematic Review of Complications and Outcomes

Background: Facelift procedures are a popular method of facial rejuvenation. The most common technique is superficial muscular aponeurotic system (SMAS) plication, with several variations. However, the optimal approach remains unclear. This review analyzed previous studies to compare SMAS facelift techniques, their outcomes, and complication rates. Methods: A systematic search was conducted using the MEDLINE, Cochrane, Embase, and Google Scholar electronic databases in September 2022. The search included studies published from January 2000 to September 2022 using keywords such as "facelift," "complications," and "outcomes." Results: This review examined 27 selected studies that evaluated 6 SMAS facelift techniques. The studies involved 6086 patients in total, over 85% of who were satisfied with the outcome of their surgery. The complication rates varied depending on the technique used, with the SMAS flap and composite SMAS technique having the highest (5.75%) and lowest (0.05%) complication rates, respectively. The most common complications were temporary facial nerve injury (0.85%) and skin necrosis (0.41%). To date, only one case of permanent facial nerve injury has been reported. Conclusions: On the basis of our findings, SMAS facelift techniques achieve high patient satisfaction rates, with complication rates that vary by technique. The composite SMAS technique showed the lowest complication rates, whereas the SMAS flap showed the highest rate. However, some studies have not reported all complications, making it difficult to determine the best approach. Therefore, future studies are required to identify the most aesthetically pleasing technique with the lowest complication risk. (c) 2023 The Authors. Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)