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Review
January 10, 2019

Advances in Face-lift Techniques, 2013-2018: A Systematic Review

Author Affiliations
  • 1Meridian Plastic Surgeons, Indianapolis Indiana
  • 2Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York
JAMA Facial Plast Surg. Published online January 10, 2019. doi:10.1001/jamafacial.2018.1472
Key Points

Questions  What are the newest and most accepted techniques for rhytidectomy reported in the literature during the past 5 years, and what is their reported efficacy?

Findings  In this systematic review of 84 English-language primary reports and systematic reviews, the literature reported a multitude of findings related to advancements in the techniques of rhytidectomy. Although most articles related to soft-tissue techniques, most of those with a high level of evidence evaluated the safety and efficacy of tissue sealants.

Meaning  Additional research is required to evaluate techniques that have been introduced from 2013 to 2018 with prospective studies and comparative groups to document efficacy.

Abstract

Importance  Rhytidectomy, or face-lift surgery, is the mainstay of facial rejuvenation and is constantly evolving. There is continuous research to improve outcomes and minimize complications of this surgery.

Objective  To synthesize the updated techniques in rhytidectomy published during the past 5 years, including surgical technique, advances in anesthetic technique, minimally invasive techniques, and adjunctive procedures performed at the time of rhytidectomy.

Evidence Review  On February 8, 2018, a literature search was performed of the PubMed and Cochrane databases using the search terms, face-lift or rhytidectomy and techniques. Articles published from February 8, 2013, to February 8, 2018, that related to techniques of facial rejuvenation in the lower one-third of the face by lifting and supporting tissue with 5 or more patients were included. Systematic reviews and primary literature were considered; narrative reviews, validation studies, and anatomic studies were eliminated. The initial search resulted in 604 articles after duplicates were removed. This was reduced to 84 articles after dual independent review screening.

Findings  Of the 84 articles included, 51 (61%) regarding techniques of face-lifting in the past 5 years pertained to soft-tissue techniques; 14 (17%) pertained to implants or adjunctive medications, such as tissue sealants; and 12 (14%) related to adjunctive techniques performed in addition to face-lifting, such as fat grafting, resurfacing, and liposuction. All studies found the techniques reported therein to be effective, with similar or fewer complications compared with the literature. However, according to the Oxford Centre for Evidence-Based Medicine criteria, the level of evidence of the studies was generally poor, because 45 of the studies (54%) were case series (level 4 of evidence).

Conclusions and Relevance  Several new techniques have been explored for rhytidectomy or face-lift in the past 5 years, including soft-tissue techniques, introduction of implants or topical medications such as tissue sealants, and concomitant adjunctive techniques to enhance results. The overall quality of the evidence is poor, with most articles using case series with nonvalidated measures to evaluate outcomes. There is considerable room for improvement in the literature if additional studies using cohort designs and validated outcomes are performed to validate the quality of the techniques introduced during the past 5 years.

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