The MACS* Lift
(*Minimal Access Cranial Suspension)

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Traditional facelift techniques can reverse changes due to aging in the lower two-thirds of the face. Their goal is to turn back the clock without leaving an unnatural or windswept look. Recovery takes at least three to four weeks before patients are comfortable appearing in public with confidence that the surgery is not noticeable.

 As I performed traditional facelifts for 18 years, I constantly sought a technique that would yield results similar to a traditional facelift, but with a shorter recovery time. The MACS lift, developed by Belgian plastic surgeons Patrick L. Tonnard, M.D. and Alexis M. Verpaele, M.D. in the late 1990s, seemed to have promise to be such an operation.

After studying their technique, I began to perform MACS lifts in 2004, and was encouraged by the results. Not only was the recovery period 10-14 days instead of the usual 3-4 weeks, but the results I obtained were actually BETTER than those with more aggressive operations. To further refine my technique, I visited Drs. Tonnard and Verpaele in Ghent, Belgium in 2005.

As of 2012, I have performed MACS lift surgery on about 100 patients from 42-76 years of age, both men and women -- some having their first facelift, some having a second or third cosmetic procedure. Patients have been very pleased with the natural, unoperated (non-surgical) appearance and the quick recovery.

The procedure can be used for almost all patients who are candidates for a standard facelift. In patients with very redundant neck skin, or in many patients over 70, a slightly more extensive procedure may be indicated (the MACS lift Plus.) As with all facelifts, results will be longer lasting in younger patients and those with good quality skin. Unlike other facelifts, the MACS lift may be repeated multiple times without sacrificing natural results as the direction of pull is directed vertically, not posteriorly.

Procedure Description: The MACS lift is an outpatient procedure that takes about 2-1/2 to 3 hours. If other procedures are added (for example, brow lift or lip augmentation), the length of time will be increased, but it will remain an outpatient procedure.

The MACS lift can be performed using local anesthesia and light sedation (twilight sleep) or with a formal general anesthetic. With either method, the patient remains comfortable throughout the procedure and awakens quickly after its completion.

The procedure generally begins with liposuction of the neck and removal of any fat collection under the chin, working through a tiny incision placed in a skin crease under the chin. Usually, only a small amount of fat is removed to improve the neck contour. This will assist in tightening the excess skin in the neck.

The MACS lift itself begins with incisions in front of the ears extending upwards inside the hairline of the sideburn to the level of the eyebrow. No incisions are made behind the ears. A small area of skin is lifted off the cheek and the underlying SMAS is gathered upwards with three sutures that are firmly attached to strong tissue at the base of the temple. This further tightens the neck, improves the definition of the jawline, and elevates the cheeks to a more youthful position in relation to the lower eyelids.

The excess skin, which has been moved upward because of its attachments to the SMAS, is trimmed at the incision and closed under minimal tension with fine sutures.

The procedure is repeated on the other side.

In almost all cases, elevation of the cheeks will cause a small roll of excess skin to appear in the lower eyelids. If present, this is removed through nearly-invisible lower eyelid incisions just below the eyelashes. Generally, only skin (not muscle or fat) is removed to avoid a hollow lower lid and to achieve a smooth transition from lid to cheek. These incisions are closed with very fine sutures.

The procedure is now complete. A soft mildly compressive "gauze helmet" dressing is applied but the entire face is uncovered. No drains are used.

Aftercare generally requires only cool compresses to the eyes, mild head elevation, and pain medication, as needed. Pain is generally mild and easily controlled. The dressing is removed the day following the procedure. The patient is allowed to shower and shampoo daily until the sutures are removed. All sutures are removed by 5-7 days after the procedure.

After the procedure: Aftercare is similar to a classic facelift. Dressings are removed in 24 hours and the patient can shower and shampoo at that time. Sutures are removed at 5 to 7 days postoperatively. Most patients can return to work at 7 days postoperatively with the use of camouflage makeup. Normal activities can be resumed at 10 days.

MACS lift animation

_Click to play the video simulation
of the MACS lift generously provided by
Drs. Tonnard and Verpaele
of the Coupure Center in Belgium

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