Excising the Extra: A Scoping Review of Direct Excision Safety, Complications, and Prevention Strategies in Facial Aesthetic Plastic Surgery

PURPOSE: Direct excision is a foundational technique. It has applications across the periorbital, nasal, and cervical regions. Our goal is to define the safety profile of direct excision and compile best practices for optimizing outcomes. To our knowledge, it has not been clearly characterized in the literature. METHODS: A structured literature search of PubMed, Embase, and Google Scholar identified studies published between 2011 and 2026 that evaluated the complications, safety, and outcomes of direct excision in facial aesthetic surgery. Following PRISMA guidelines, 11 studies were included. Complications were classified as major, early minor (within 30 d), or late minor (beyond 30 d). RESULTS: Eleven studies encompassing 410 patients across periorbital (n=65, 15.8%), nasal (n=107, 26.1%), and cervical (n=238, 58%) regions were analyzed. No major complications were identified in the periorbital or nasal direct excision. Periorbital early minor complications included transient lower eyelid dislocation (3/53, 5.7%) and edema (N not reported). Scarring was the predominant reported late sequela across all regions. Nasal yielded delayed wound healing (2/21, 9.5%) and hypertrophic scarring (3/21, 14%). Cervical cancer carried the highest complication burden. This included hematomas requiring emergent reoperation (2/112, 1.8%), ecchymosis (10/47, 21.3%), hypertrophic scarring (8/47, 17%), sialocele (5/112, 4.5%), and marginal mandibular neurapraxia (5/112, 4.5%). CONCLUSIONS: Direct excision demonstrates a favorable safety profile across the periorbital and nasal regions. Major complications were confined to the cervical region. Preoperative patient selection, meticulous intraoperative technique, and prompt recognition of postoperative complications are essential. Future prospective studies with standardized reporting of complications are needed to strengthen evidence-based recommendations.