What it means for a patient
- In the pooled studies, about 1 in 15 deep plane facelift patients had some complication, and none had permanent facial nerve injury.
- Temporary nerve weakness occurred in about 1 in 80.
- The finding of better aesthetic results rests on subjective ratings.
- Limits: included studies ranged from trials to case series, and the authors call for randomized studies, standard outcome measures and long-term follow-up.
Why this paper matters
It gives pooled complication rates for the deep plane facelift from over 10,000 patients. It addresses the concern about permanent facial nerve injury, which was not observed in the included studies.
Overview
The deep plane facelift, first described by Sam Hamra in 1990, is widely used, but concern about complications, most of all permanent facial nerve injury, leads some surgeons to choose SMAS facelifts instead. The authors pooled trials, cohort studies, case-control studies and case series of deep plane facelifts following PRISMA standards. They measured complication rates and compared aesthetic results with subcutaneous and SMAS facelifts.
Findings
- 45 studies; 10,784 deep plane facelift patients.
- Pooled overall complication rate: 6.6%.
- Permanent facial nerve injury: none observed.
- Temporary facial nerve injury: 1.2%.
- Hematoma: 1.8%.
- Seroma: 1.7%.
- Infection: 0.8%.
- Hypertrophic scarring: 2.8%.
- Epidermolysis: 1.2%.
- Skin necrosis: 0.1%.
- Aesthetic results showed greater improvement with deep plane facelift than subcutaneous and SMAS facelifts, but assessment methods were subjective.
- Level of evidence: III.
Terms
- Deep plane facelift: a facelift that lifts the skin and the deeper SMAS layer together as one flap.
- SMAS facelift: a facelift that treats the SMAS layer separately from the skin.
- Subcutaneous facelift: a facelift that lifts the skin only.
- Epidermolysis: loss of the top layer of skin.
- Skin necrosis: death of an area of skin from poor blood supply.
- Hypertrophic scarring: a raised, thick scar that stays within the wound edges.
- Meta-analysis: a method that pools results from many studies into one estimate.
- PRISMA: a standard checklist for reporting systematic reviews.