An Evidence-Based and Case-Based Comparison of Modern Face Lift Techniques

Background: Facial aging is a multifactorial process that affects each component of facial anatomy. The two general groups of facelift techniques are superficial musculoaponeurotic system (SMAS) elevation and SMAS manipulation. The purpose of this article is to describe and compare the advantages, disadvantages, and limitations of facelift techniques. Methods: A systematic review was performed to describe current outcomes evidence for facelift technique. A subcohort of articles were selected for case-based analysis based on designated facial assessment criteria. Analysis was performed to determine the advantages, disadvantages, and limitations of each respective technique. Results: A total of 65 articles were selected for systematic review of which 15 articles met criteria for case-based review. Patient satisfaction was found to be equivocal for various facelift techniques. Specific advantages and disadvantages for each facelift technique were dependent on the techniques’ approach to skin shift vector along with its degree of mobilizing superficial facial fat. Facial fat grafting was universally applicable for restoration of deep malar volume. Facial fat grafting was also used differently depending on the SMAS technique to address its specific limitations. Conclusion: Our review confirms that there are many methods to obtain excellent outcomes in facial rejuvenation. Experienced surgeons are able to obtain consistent results through a variety of techniques based on understanding the aesthetic needs of the individual patient, the quality of the soft tissues being manipulated, as well as how to vary a specific technique to reach desired aesthetic endpoints.