Table 1. Summary of clinical studies on reconstructive rhytidectomy techniques, outcomes, and considerations over the past 20 years (2004-2024).

DM, diabetes mellitus; SHT, systemic hypertension; SMAS, superficial musculoaponeurotic system

Source: [10-22]

References	Study design	Patient age and gender	Pathological anomaly presented	Surgery technique(s)	Patient's medical history	Postoperative results	Advantages	Disadvantages
Wirth et al. [10]	Case report	A female in her mid-30s	Oculopharyngeal muscular dystrophy	-	Alopecia totalis of unknown origin, low blood pressure, and Graves' disease believed to be secondary to thyroiditis. She was prescribed Synthroid, Prozac, Estrace, and Provera. For pain management, she frequently took Percocet and used Atarax at night to aid sleep. She took Prilosec, urecholine, and Propulsid to address gastrointestinal symptoms.	The patient made a remarkable recovery, with no complications arising from the surgery or the recovery period. Just days after the procedure, she was able to discontinue some pain medications that she had been taking chronically for several years.	There were no complications related to the surgery or the recovery period. Within days after the procedure, the patient was able to discontinue some pain medications that she had been taking chronically for several years.	No disadvantages reported
García-Díez et al. [11]	Observational study	3 males and 4 females aged 28-50 years of age	Lateral mandibular defects due to the resection of benign mandibular tumors	A combined rhytidectomy technique utilizing an intraoral incision was employed for mandibular resection and the reconstruction of defects with vascularized free osseous flaps.	-	The iliac crest was utilized for reconstruction in six cases, while one patient received a fibula graft. Two patients experienced transient paresis of the marginal nerve, and one patient suffered flap loss, necessitating repeat microvascular surgery. Dental rehabilitation with osseointegrated implants was conducted for four patients. All patients achieved successful mandibular reconstruction, with functional outcomes rated as excellent for everyone.	Provides excellent access to the posterior mandible and facilitates predictable identification of neural and vascular structures; associated with minimal morbidity compared to traditional neck incisions; achieves a natural facial contour, perfect symmetry, and an inconspicuous scar; allows for microvascular mandibular reconstruction in a single stage, enabling quicker recovery for patients. The technique preserves the original attached gingiva, which is beneficial for dental rehabilitation.	The surgical field can be restricted, especially when recipient vessels are deeper and located in a lower cervical area; is not indicated for cases requiring extensive extramandibular margins during tumor resection. There is a risk of complications such as transient facial paralysis and flap loss, although these are generally manageable. It may demand a high level of skill and experience from the surgical team to achieve optimal outcomes.
Yamamoto et al. [12]	Observational study	120 patients, with a female-to-male ratio of 54:6 in the Tisseel group and 55:5 in the Artiss group. The average ages for the Tisseel and Artiss groups were 63 and 60 years, respectively.	Hematoma, fluid accumulation necessitating needle aspiration, seroma, flap necrosis, infection, and nerve damage	Artiss (Baxter) and fibrin tissue sealants	-	In the study involving tissue sealants, the Tisseel group reported two cases of fluid collection that required needle aspiration, with no other complications noted. In contrast, the Artiss group experienced 10 complications, including nine fluid collections needing aspiration and one hematoma. Among 179 respondents, 34% reported using tissue sealants in rhytidectomies, while 66% did not. Artiss is effective and safe for rhytidectomies, eliminating the need for surgical drains, with a complication rate comparable to Tisseel.	Fibrin: sealant included the elimination of the need for surgical drains (59%), ease of use (47%), a reduction in hematoma, edema, or fluid accumulation (47%), and simplified postoperative care (41%).	Fibrin: sealant included higher costs (90%), the risk of infection or allergic reactions (33%), the need for education of operating room staff (33%), and limited availability (23%).
Jacono et al. [13]	Observational study	300 hemifaces were operated on, consisting of 147 females and 3 males. The average age of the patients was 60 years.	Patients seeking surgery for functional problems, including facial paralysis or other reconstructive reasons, were not included.	Extended deep plane rhytidectomy	The duration between previous aesthetic facial surgeries and the revision rhytidectomy for patients was recorded.	The mean resultant angle for the cohort was measured at 60° from the horizontal, with a range of 46°-77°. An inverse correlation was observed between the angle and patient age (r = –0.3). Younger patients (under 50 years) exhibited a significantly more vertical angle of 64° compared to older patients (70 years and above), who had an angle of 56°. There were no significant differences between the hemifaces of different subjects.	A new technique was introduced for determining the angle of maximal rejuvenation during rhytidectomy. In all cases, this angle was found to be more superior than posterior and is closely associated with the patient's age. Achieving lasting results requires a thorough anatomical understanding and meticulous attention to both the direction and degree of skin laxity.	No disadvantages reported
Zhou et al. [14]	Observational study	54 patients; all were female, aged 44-69 years	Forehead wrinkles, crow's feet, fullness in the upper cheeks, fullness in the lower cheeks, nasolabial folds, and jawline definition	Stepped lift of the superficial musculoaponeurotic system	-	The overall complication rate for the current surgical approach was 7.40%. This technique led to reduced operating time and drainage volume compared to previous methods. All patients were satisfied with their results, feeling they looked 8.3 years younger than their actual age. The highest satisfaction was noted in the midface, temple, and nasolabial folds, with significant improvements evident in pre- and postoperative photographs.	The modified facelift procedure, along with the stepped superficial musculoaponeurotic layer lift technique, proved effective for elderly patients with significant facial wrinkles and ptosis, delivering a long-lasting, natural, and youthful appearance.	No disadvantages reported
Rezende et al. [15]	Randomized controlled trial	72 female patients aged 43-79 years	Signs of facial aging, including flaccidity, ptosis, and wrinkles, indicating a medical need for rhytidoplasty for aesthetic reasons	Autologous fibrin glue/platelet-poor plasma and suction drainage	Smoking, DM, and SHT	The average total volume of exudate was 3.21 mL in the suction drainage group compared to 1.02 mL in the fibrin glue group, yielding an effect size of 68.1% with a confidence interval of 55.3-77.2. The results strongly support the use of fibrin glue, demonstrating that it was 68.1% more effective than suction drainage in preventing hematoma or seroma during rhytidectomy procedures.	-	-
Rohrich et al. [16]	Observational study	83 male and 83 females; the mean age was 59 years	Hematoma, seroma, skin sloughing, alopecia, infection, and nerve injury	Facelift flap	Hypertension	The study emphasizes the differences in facial analysis and rhytidectomy techniques between male and female patients. In the control group, five male patients (6%) experienced postoperative hematoma, while no female patients were affected. There were no other complications reported.	By considering the natural patterns of hair growth in incision design, ensuring that follicles are not harmed during dissection, and adhering to standard care practices to prevent postoperative hematomas, it has achieved safe, consistently reproducible aesthetic results with acceptable rates of complications.	No disadvantages reported
Saha [17]	Observational study	10 patients (8 males and 2 females) aged between 21 and 78 years	Without complications	Facelift flap	Superficial necrosis occurring in one patient (10%) and mild venous stasis in three patients (30%)	The augmented facelift flap effectively reconstructed defects in the medial cheek, lateral orbit, and lower eyelid, yielding aesthetically pleasing outcomes. Of the patients, nine (90%) healed without long-term complications. Short-term complications included superficial necrosis in one patient (10%) and mild venous stasis in three patients (30%), with no cases of flap loss or infection reported. Overall, patient satisfaction scores ranged from 50% to 90%, with an average of 78%.	The augmented facelift flap effectively reconstructed post-traumatic facial defects in the cheek, lateral orbit, and lower eyelids, achieving satisfying aesthetic outcomes.	No disadvantages reported
Campo [18]	Observational study	672 patients, along 19 years	Temporary hypoesthesia may occur in the forehead or cheeks, along with occasional temporary palsy of the frontotemporal branch of the facial nerve.	Mini-invasive facelift	-	The results are more long-lasting because this technique alleviates the weight exerted by the descent of deep tissues against the skin, enabling it to regain some of its lost elasticity. These procedures are highly safe and pose fewer risks compared to other deep plane facelift techniques.	This technique helps restore the facial structure, enhance cheekbone prominence, redistribute lax skin, and indirectly tighten the skin.	No disadvantages reported
Kao et al. [19]	Observational study	600 patients	-	Ponytail lift	-	There were no occurrences of postoperative skin flap necrosis, and no permanent nerve injuries were reported. In 20 cases, an additional surgical touch-up procedure was conducted to address unmet aesthetic needs.	This approach offers a deep plane facelift without the burden of visible scars, as the incisions are concealed within the temple scalp, post-auricular area, and posterior scalp. The techniques outlined are both safe and effective, delivering reliable and satisfying results.	No disadvantages reported
Siemionow et al. [20]	Case report	A 45-year-old female	Her facial deformities comprised the absence of the nose, nasal lining, and underlying bone; contracted remnants of the upper lip; loss of function in the orbicularis oris and orbicularis oculi muscles; distorted and scarred lower eyelids deficit, resulting in impaired midface function.	Composite face allotransplantation	With severe midface trauma, she underwent a near-total face transplantation, during which 80% of her face was replaced with a customized composite tissue allograft.	The rejection was successfully reversed with a single bolus of corticosteroids. In the initial 3 weeks following the transplantation, the patient adapted to her new face. Six months after the surgery, her functional outcome has been outstanding. Compared to her condition prior to the procedure, she can now breathe through her nose, enjoy her sense of smell and taste, speak clearly, consume solid foods, and drink from a cup.	The viability of reconstructing severely disfigured patients through a single surgical procedure utilizing composite face allotransplantation was demonstrated.	No disadvantages reported
Gadallah et al. [21]	Case report	50 female patients between 30 and 56 years of age	-	Deep plane facelift	-	Patient and surgeon satisfaction with postoperative cosmetic outcomes was evaluated using a proforma scale, where scores ranged from 1 for poor results to 5 for excellent results.	A high score of both satisfaction grades was perceived.	During the follow-up, we observed four cases of seroma, four instances of facial mandibular nerve neuropraxia, five cases of scar hypertrophy, two occurrences of wound infection, and one case of pixie ear deformity.
Cohen et al. [22]	Observational study	34 patients (31 females and 3 male), aged 50-77 years	Minor epidermolysis occurred at the junction of the postauricular incision and the hairline; significant laxity and retroauricular hematoma	Facelift with power-assisted dissection	Photodamage, subcutaneous deep and superficial fat compartment loss and bone loss and/or pre-existing skeletal deficiency, and laxity	The dissection of skin flaps and SMAS elevation were completed more quickly than with traditional techniques. There was a notable reduction in bleeding. The skin flaps showed improved perfusion, exhibiting less venous engorgement and ecchymosis compared to those created with sharp scissor dissection. Overall, patients experienced shorter postoperative recovery times and reduced social downtime due to less bruising and edema.	The duration of the procedure has been shortened, and patients have encountered less social downtime compared to our previous experience with scissor dissection.	-