The MACS Lift… how it differs from Conventional Facelifts

 by: Mr A RICHARDS MSc FRCS (Plas)

Background

The MACS lift (minimal access cranial suspension lift) was described as a modification of the S-lift by a Belgian group in 2001. It was reported in the Plastic & Reconstructive Surgery journal, which is the main scientific journal for plastic surgeons.

Essentially, it differs from a regular facelift in the following ways:

1. The incision is limited to the skin hairline junction above the ear and anterior to the ear. There is no extension behind the ear.

2. The area of undermining, unlike a conventional facelift, is much smaller and essentially involves a portion of the cheek. Because there is less undermining, the blood supply to the skin is much more robust and the technique is therefore safer in smokers. There is much less risk of any skin necrosis, unlike other lifts.

3. Permanent suspension sutures are used to elevate the underlying tissue. These pass down to the neck, jowls and malar fat pad. Unlike many other facelifts which do not include significant mid face elevation the MACS lift elevates the malar fat pad reducing the naso labial folds.

4. Because there is no undermining under the SMAS (superficial musculoaponeurotic system) there is very little likelihood of damage to the facial nerve.

5. Because the undermining and dissection is much more limited the post operative swelling and oedema is much less than in normal facelifts and recovery is therefore quicker.

6. Because the malar fat pad is elevated it combines very well with lower lid blepharoplasty, as can be seen in the illustrations. It essentially reduces the height of the lower eyelid giving a more youthful, smooth appearance.

7. In nearly all cases liposuction is performed to the neck area below the angle of the mandible, both to remove excess fat here and also to free up the skin to allow it to be re-draped by the suspension sutures.

8. In my opinion the MACS lift produces results at least equivalent, or in most cases, better than a conventional facelift. It is ideally suited to the younger patient with a sagging mid face. In patients with really excess skin facility in the neck region, it may be necessary in some cases to make an incision posterior to the ear to take up this slack, but in most cases this is not necessary.

DETAILS OF PROCEDURE

The operation is performed under a general anaesthetic and most patients stay in hospital for two days post operatively. The operation generally takes about three hours and in nearly all cases should be combined with lower lid blepharoplasty, as lifting up the malar fat pad also lifts up the lower eyelids and it is relatively simple to remove the excess skin. Usually no additional work needs to be done to the fat pads because of the suspension of the malar area.

During the post operative night, the patient is placed in a firm bulky woollen bandage and two small non-suction drains are inserted behind the ear. The bandage is removed the following day, along with the drains. Following this, a light chin-up bandage is worn for one week. Following this, the patient normally looks fairly reasonable, although there may be some residual bruising, particularly around the eyes. This is treated with Arnica cream and massage on a twice daily basis.

Stitches in the lower blepharoplasty incision are removed at three days, those in front of the ears and alternate stitches in the hairline are removed at five days and the remaining sutures in the hairline at ten days.

In my opinion the MACS lift is a significant advancement in facial rejuvenation surgery as it involves relatively little undermining and consequently the recovery is quicker. It also has the significant advantage of improving the mid face and malar area which other facelift techniques do not tend to help.

I use this type of facelift now exclusively, and as I mentioned, in patients with really severe neck skin excess I would do a posterior skin excision, but this is not necessary in 90% of patients.

This lift is ideally suited to the younger patient with mid face ageing changes and moderate changes in the neck.