SMAS Plication Facelift and Platysmaplasty Under Tumescent Local Anesthesia: A 10-Year Retrospective Evaluation of Safety, Efficacy, and Patient Satisfaction in an Outpatient Setting.

INTRODUCTION: Facial rejuvenation increasingly uses techniques targeting the Superficial Muscular Aponeurotic System (SMAS) for natural, durable results. Advances in anesthesia, especially tumescent local anesthesia (TLA), have enhanced the safety and recovery of complex aesthetic procedures. This study evaluates the efficacy and safety of SMAS plication facelift, platysmaplasty, and neck liposuction under TLA in an outpatient setting over the past decade.
METHODS: Between 2012 and 2022, eighty ASA I-II patients (mean age 56, range 47-65) underwent SMAS plication facelift, midline platysmaplasty, and submental liposuction under TLA. Preoperative workup included blood tests, ECG, and cardiology clearance. The tumescent solution (25 mL 2% lidocaine, 8 mEq sodium bicarbonate, 1 mL epinephrine in 1000 mL saline) was infiltrated at 100 mL per hemiface. Midazolam sedation was administered as needed. Surgical time averaged 150 min, including 40 min for TLA. Patients were monitored for three hours postoperatively and followed up to 36 months.
RESULTS: The mean infiltrated volume was 200 mL per patient. There was no lidocaine or epinephrine toxicity, and no conversions to general anesthesia (GA). Over 36 months, complications occurred in 10%: hematoma (2.5%), seroma (1.25%), scarring (3.75%), paresthesia (1.25%), and "pixie ear" (1.25%). No infections or anesthesia-related events were observed. Patients reported high satisfaction, rapid recovery, and minimal discomfort.
CONCLUSION: TLA effectively replaces GA for SMAS plication facelift with platysmaplasty and neck liposuction. It offers sufficient analgesia, supports precise dissection with less bleeding, and minimises postoperative edema and ecchymosis, leading to quicker recovery and improved patient comfort and satisfaction.
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