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Deep Plane Versus SMAS Plication Facelift: A Prospective Cohort Study of Clinical Outcomes and Complication Rates
Omar Fouda Neel1,2, Mohammed Naif Alsubhi3, Haneen Alotaibi4
1Division of Plastic Surgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia.
Background:
Facelift surgery is a cornerstone of facial rejuvenation, yet the optimal technique remains debated. This prospective cohort study compared outcomes and complication rates between the deep plane and superficial musculoaponeurotic system (SMAS) plication facelift techniques.
Methods:
A total of 166 patients undergoing primary facelift surgery by a single surgeon between January 2019 and December 2024 were prospectively enrolled. Patients were allocated to the deep plane (n = 45, 27.1%) or SMAS plication (n = 121, 72.9%) groups. Data collected included demographics, operative characteristics, aesthetic outcomes, patient satisfaction, recovery duration, and complications.
Results:
The median patient age was 49 years (IQR 42.7-56), with most being female (95.2%) and overweight (46%). Baseline characteristics were comparable between groups. Facial rejuvenation was rated as excellent in 70.5% of SMAS cases versus 29.5% of deep plane cases (p = 0.67). Patient satisfaction was high in both groups (p = 0.09), and recovery duration was similar (median 25.5 vs. 30 days, p = 0.65). Overall complication rates did not differ significantly (21.6% vs. 28.7%, p = 0.39), including transient facial nerve weakness (11.1% vs. 12.4%, p = 0.70). Concurrent ancillary procedures were similarly distributed between groups (93.3% vs. 95.9%, p = 0.79). Logistic regression identified no significant predictors of outcome or interaction effects.
Conclusions:
Deep plane and SMAS plication facelifts demonstrated comparable early postoperative outcomes with no significant differences in patient satisfaction, rejuvenation ratings, recovery, or complication rates within a median follow-up of three months. These findings should be interpreted in the context of short-term follow-up, unequal group sizes, and the absence of validated outcome instruments. Both techniques appear safe and effective in the early postoperative period, with results largely influenced by surgical expertise and patient selection rather than technique alone LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
