Modern Facelift: surgical anatomy, smas and deep-plane techniques, outcomes, and complication prevention - a narrative review

Abstract

Introduction: Surgical facial rejuvenation has evolved from skin-only traction toward carefully planned mobilization of deeper tissue compartments to restore contour and avoid an unnatural appearance. Objective: To critically examine anatomy, technique selection, outcomes, and complications of contemporary rhytidectomy, focusing on superficial musculoaponeurotic system (SMAS) and deep-plane methods. Methods: Narrative review of anatomical studies, systematic reviews, and hematoma prevention evidence available through October 2026; no original meta-analysis was performed. Discussion: Retaining ligaments, facial fat compartments, facial nerve anatomy, neck management, SMAS plication, SMASectomy, composite flaps, and sub-SMAS dissection are reviewed alongside photographic planning, risk assessment, anesthetic considerations, and follow-up. Synthesis: Both approaches provide improvement and high patient satisfaction, but comparative evidence remains heterogeneous and does not demonstrate unequivocal overall superiority. Hematoma, skin compromise, and transient nerve dysfunction require special attention; blood-pressure control, meticulous hemostasis, and patient selection are relevant preventive measures. Conclusion: Dissection plane should be chosen according to anatomy, tissue quality, facial descent, surgical expertise, and safety rather than marketing-driven preferences.