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Hello, this is Dr. Choi Jae-Ik from AB Plastic Surgery.
Have you heard of facelifting surgery?

Many people think of it as a major and complicated procedure and are worried about potential complications—especially facial paralysis after surgery.
Today, I would like to help ease those concerns by sharing insights from medical studies on facelift complications.

Q. What is the SMAS Facelift Technique?

SMAS refers to the Superficial Musculo-Aponeurotic System, a layer of connective tissue that links facial expression muscles. Beneath this SMAS layer, important facial nerves responsible for expressions run through. Based on this anatomical knowledge, various surgical techniques have been developed.

Here are the main SMAS facelift techniques:

1.SMAS Plication: This method involves pulling and suturing the SMAS layer. It poses a low risk of nerve damage and helps improve facial volume.

2.SMAS Excision: This involves cutting and lifting the SMAS. Dissection beneath the SMAS is minimal or absent, resulting in a lower risk of nerve damage.

3.SMAS Dissection: This approach includes a more extensive dissection of the SMAS. Depending on incision and dissection range, variations include SMAS lift, High SMAS, Deep Plane, and Composite Lift.

Most facelifts in plastic surgery are performed using SMAS dissection techniques.

Q. What Do Scientific Studies Say About Facelift Complications?

Research identifies the main complications of facelift surgery as nerve injury, hematoma, skin necrosis, and infection. Let’s look at each in detail:

1.Nerve Damage: Temporary nerve damage occurred at a rate of 0.69% in SMAS plication, 0.84% in SMAS excision, and 0.69% to 1.85% in SMAS dissection procedures. Permanent nerve damage was extremely rare, and even in cases where

nerve damage did occur, most patients recovered over time. In SMAS lift and High SMAS lift methods, the incidence was reported as 0.04% to 0.08%.

2.Hematoma: The incidence rates for hematoma (blood pooling after surgery) were 0.7% for SMAS plication, 1.9% for SMAS excision, and 0.85% for SMAS dissection. What's interesting here is revealed through the odds ratio. The odds ratio is calculated

by dividing the probability of an event occurring by the probability of it not occurring; if this value is greater than 1, it suggests a higher likelihood of the event happening.

In this context, when compared to SMAS plication, SMAS dissection showed a statistically significant reduction in odds ratio, ranging from 0.07 to 0.46. My personal opinion is that thorough and precise SMAS dissection may help lower the probability o

hematoma as a side effect.

3.Skin Necrosis: In the case of skin necrosis, the incidence rate ranged from 0.7% to 1.6% based on SMAS plication, and SMAS dissection showed a statistically significant increase compared to SMAS plication (Odds Ratio 2.29). This is likely because the

wider range of skin dissection leads to more skin damage. In particular, smoking is one of the main causes of necrosis by restricting blood flow, so smokers are advised to quit smoking one month before surgery. If you have high blood pressure or

diabetes, the risk of necrosis can be higher, so thorough consultation with the surgeon before surgery can reduce the risk of this side effect.

4.Infection: Most surgical methods showed an incidence rate of around 0.2% to 1%. Soft tissue side effects like this (infection) can be considered a risk factor if there are pre-existing retroauricular abscesses, fistulas, or inflammation before surgery. To

prevent this disease, thorough consultation regarding pre-operative preparation and cleanliness is necessary.

Q. What’s the Truth About Facelift Side Effects?

What we learn from the data is that permanent nerve damage is extremely rare.

While some variation exists in complication rates depending on the surgical technique, the overall risk remains low—around 1–2%. Most complications resolve with conservative treatment and do not require additional surgery. Therefore, patients

shouldn't base their surgical decision solely on fear of side effects. Instead, it is more important to choose the right surgical method tailored to each patient through thorough consultation.

In fact, many complications worsen only when not addressed early. At AB Plastic Surgery, we require mandatory follow-up the day after surgery, minimizing even minor risks and giving you peace of mind.

We will continue exploring different types of lifting surgeries in future posts. Thank you for reading.

If you have more questions about facelift surgery, please call +82-10-5159-1298 or contact AB Plastic Surgery on WhatsApp using the same number above, for more detailed consultation.

Writer

Dr. Choi Jae-Ik, AB Plastic Surgery

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