Abstract

Background
The deep plane facelift first described by Dr. Sam Hamra in 1990 is a well-established approach to addressing facial aging however despite being widely adopted and adapted since its introduction concerns regarding the complications associated with the technique persist, with permanent injury to the facial nerve being the most feared. As a result, many surgeons may opt for alternative approaches such as the SMAS facelift, which may not provide as effective results. This systematic review and meta-analysis aimed to evaluate the complication rates of deep plane facelifts, and the aesthetic outcomes compared with subcutaneous and SMAS facelift techniques.

Methods
A systematic review and meta-analysis was performed according to PRISMA standards. Randomised controlled trial, cohort studies, case controls, and case series describing deep plane facelifts were included. Primary outcomes were overall complications including temporary or permanent facial nerve injury, haematoma, infection, seroma, skin necrosis, hypertrophic scarring and epidermolysis. Secondary outcomes were aesthetic outcomes compared to subcutaneous and SMAS facelifts. A random effects model was used for data analysis and results were reported in forest plots with 95% confidence intervals (CI).

Results
Forty-five studies involving 10,784 patients undergoing deep plane facelift were included. The pooled overall complication rate was 6.6%. No instances of permanent facial nerve injury were observed. Temporary facial nerve injury occurred at an estimated rate of 1.2%, haematoma in 1.8%, seroma in 1.7%, infection in 0.8%, hypertrophic scarring in 2.8%, epidermolysis in 1.2%, and skin necrosis in 0.1%. Aesthetic outcomes demonstrated superior improvement with the deep plane facelift, although assessment methods were subjective.

Conclusion
Deep plane facelift is a safe and effective technique with low complication rates and favourable aesthetic outcomes. Further randomised studies and standardised outcome measures are needed to support this finding, along with long-term follow up to assess the durability of the technique.

Level of Evidence III
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