Evaluating Facelift Complications and the Effectiveness of the Smasectomy Technique: A Single Center’s 15-Year Experience

Goals/Purpose: Facelift continues to be one of the most common aesthetic procedures performed in the United States. Although there exist many techniques and variations, SMAS manipulation, by way of plication, overlap or SMASectomy are common and have been shown to result in favorable cosmesis and durability. However, there is a lack of current complications data in the discussion of this technique. In this study, operative outcomes of facelift procedures performed at a private outpatient center were examined in order to determine complication rates of SMAS manipulating procedures as compared to other techniques. Additional perioperative benefits of SMAS dissection, including decreased anesthesia time and overall operative time, which may decrease patient risk factors of DVT and improve overall outcomes, were also explored.

Methods/Technique: The records of all patients who underwent a facelift procedure between December 2004 and March 2019, were reviewed for this study. All procedures were performed at an AAAASF-accredited outpatient facility in Marina Del Rey, California. This represents data on 241 total patients. Retrospective chart review was performed to include data on patient characteristics, operative technique, and complications.

Results/Complications: Average operative time of 152.68 ± 51.50 minutes and anesthesia time of 175.00 ± 54.07 minutes was observed amongst those patients that underwent SMASectomy. This was significantly lower (p < 0.000001) than those that did not undergo SMASectomy (average operative time of 265.25 ± 85.25 minutes and anesthesia time of 294.22 ± 85.31 minutes). There were no observed facial nerve injuries among patients that underwent SMASectomy, and this technique was not associated with a significant increase in overall complications (p = 0.602). Caprini scores were also calculated for 148 patients (61.41%), with a mean score of 4.28 ± 1.62, representing an average moderate risk of DVT among these patients (Figure 6). However, no DVT events were observed in this patient population.

Conclusion: In the hands of an experienced surgeon, the SMASectomy facelift technique offers the unique advantage of significantly reducing operating time and anesthesia time and can provide extremely favorable and long-lasting aesthetic results. In addition, there may be a reduced risk of thromboembolic events due to less total time in the operating room. The authors recommend that SMASectomy be the primary facelift technique offered to patients both for the reduced potential VTE risk, as well as for the exceptional aesthetic outcomes already well documented in the literature.