{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T10:16:58Z","timestamp":1792232218271,"version":"4.4.0"},"reference-count":190,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2019,2,15]],"date-time":"2019-02-15T00:00:00Z","timestamp":1550188800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,8,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Sub-superficial musculo-aponeurotic system (SMAS) rhytidectomy techniques are considered to have a higher complication profile, especially for facial nerve injury, compared with less invasive SMAS techniques. This results in surgeons avoiding sub-SMAS dissection.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>The authors sought to aggregate and summarize data on complications among different SMAS facelift techniques.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A broad systematic search was performed. All included studies: (1) described a SMAS facelifting technique categorized as SMAS plication, SMASectomy\/imbrication, SMAS flap, high lateral SMAS flap, deep plane, and composite; and (2) reported the number of postoperative complications in participants. Meta-analysis was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total 183 studies were included. High lateral SMAS (1.85%) and composite rhytidectomy (1.52%) had the highest rates of temporary nerve injury and were the only techniques to show a statistically significant difference compared with SMAS plication (odds ratio [OR] = 2.71 and 2.22, respectively, P &amp;lt; 0.05). Risk of permanent injury did not differ among techniques. An increase in major hematoma was found for the deep plane (1.22%, OR = 1.67, P &amp;lt; 0.05) and SMAS imbrication (1.92%, OR = 2.65, P &amp;lt; 0.01). Skin necrosis was higher with the SMAS flap (1.57%, OR = 2.29, P &amp;lt; 0.01).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>There are statistically significant differences in complication rates between SMAS facelifting techniques for temporary facial nerve injury, hematoma, seroma, necrosis, and infection. Technique should be selected based on quality of results and not the complication profile.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of Evidence: 2<\/jats:title>\n                  <jats:p\/>\n               <\/jats:sec>","DOI":"10.1093\/asj\/sjz045","type":"journal-article","created":{"date-parts":[[2019,2,15]],"date-time":"2019-02-15T11:00:11Z","timestamp":1550228411000},"page":"927-942","source":"Crossref","is-referenced-by-count":86,"title":["A Meta-Analysis of Complication Rates Among Different SMAS Facelift Techniques"],"prefix":"10.1093","volume":"39","author":[{"given":"Andrew A","family":"Jacono","sequence":"first","affiliation":[{"name":"Section Head of Facial Plastic and Reconstructive Surgery, North Shore University Hospital, Manhasset, NY"},{"name":"Associate Clinical Professor in the Division of Facial Plastic and Reconstructive Surgery, Albert Einstein College of Medicine, Bronx, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A Sean","family":"Alemi","sequence":"additional","affiliation":[{"name":"Surgical fellow at a private facial plastic surgery practice in New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph L","family":"Russell","sequence":"additional","affiliation":[{"name":"Facial plastic surgeon in private practice in North Charleston, SC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,2,15]]},"reference":[{"key":"2023011216265571600_CIT0001","first-page":"300","volume-title":"The Aging Face: Plastic Surgery: New Methods and Refinements","author":"Skoog","year":"1974"},{"issue":"1","key":"2023011216265571600_CIT0002","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1097\/00006534-197607000-00013","article-title":"The superficial musculo-aponeurotic system (SMAS) in the parotid and cheek area","volume":"58","author":"Mitz","year":"1976","journal-title":"Plast Reconstr Surg"},{"issue":"1","key":"2023011216265571600_CIT0003","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/00006534-197407000-00001","article-title":"Should the subcutaneous tissue be plicated in a face lift?","volume":"54","author":"Tipton","year":"1974","journal-title":"Plast Reconstr Surg"},{"issue":"5","key":"2023011216265571600_CIT0004","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1097\/01.prs.0000207402.53411.1e","article-title":"A clinical retrospective study comparing two short-scar face lifts: minimal access cranial suspension versus lateral SMASectomy","volume":"117","author":"Prado","year":"2006","journal-title":"Plast Reconstr Surg"},{"issue":"1","key":"2023011216265571600_CIT0005","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1097\/PRS.0b013e3181ce1806","article-title":"Longevity of SMAS facial rejuvenation and support","volume":"126","author":"Sundine","year":"2010","journal-title":"Plast Reconstr Surg"},{"issue":"3","key":"2023011216265571600_CIT0006","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1097\/00006534-199809010-00041","article-title":"SMAS rhytidectomy versus deep plane rhytidectomy: an objective comparison","volume":"102","author":"Kamer","year":"1998","journal-title":"Plast Reconstr Surg"},{"issue":"1","key":"2023011216265571600_CIT0007","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1001\/archfaci.6.1.8","article-title":"Deep-plane face-lift vs superficial musculoaponeurotic system plication face-lift: a comparative study","volume":"6","author":"Becker","year":"2004","journal-title":"Arch Facial Plast Surg"},{"issue":"7","key":"2023011216265571600_CIT0008","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1097\/00006534-199612000-00001","article-title":"Is there a difference? 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