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

BACKGROUND: Facial rejuvenation increasingly uses techniques targeting the Superficial Muscular Aponeurotic System (SMAS) to achieve natural and durable outcomes. Advances in anesthesia, especially tumescent local anesthesia (TLA), have enhanced the safety and recovery of complex aesthetic procedures. This study presents a 10-year retrospective evaluation of SMAS plication facelift with platysmaplasty and submental liposuction under TLA, focusing on safety, efficacy, and patient satisfaction. METHODS: Between January 2012 and December 2022, 80 consecutive ASA I-II patients (mean age 56.3 ± 4.8 years, BMI 23.4 ± 2.1 kg/m2) underwent SMAS plication facelift with midline platysmaplasty and neck liposuction under TLA. The anesthetic solution consisted of 25 mL 2% lidocaine, 8 mEq sodium bicarbonate, and 1 mL epinephrine in 1000 mL saline, yielding a final concentration of 0.049% lidocaine with 1:1,000,000 epinephrine. Mean total lidocaine dose was 100 ± 5 mg (1.4 ± 0.07 mg/kg). Mild sedation with diazepam 0.05-0.25 mg/kg was administered as needed. Median follow-up was 28 months (IQR 24-36). RESULTS: The mean infiltrated volume was 200 ± 30 mL per patient. No conversions to general anesthesia occurred. Complication rate was 10%, including hematoma (2.5%), seroma (1.25%), dystrophic scarring (3.75%), transient paresthesia (1.25%), and pixie ear deformity (1.25%). No infections or anesthesia-related events were recorded. Patient-reported satisfaction averaged 4.01/5, with high satisfaction regarding postoperative pain management. CONCLUSION: This ten-year case series demonstrates TLA as a safe and effective alternative to general anesthesia for SMAS plication facelift in selected patients. The technique provides adequate analgesia, supports precise dissection with less bleeding, and minimizes postoperative edema and ecchymosis, leading to quicker recovery and improved patient comfort and satisfaction. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .