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:
The incision is limited to the skin hairline
junction above the ear and anterior to the ear. There is no
extension behind the ear.
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.
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.
Because there is no undermining under the
SMAS (superficial musculoaponeurotic system) there is very
little likelihood of damage to the facial nerve.
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.
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.
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.
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.
About The Author
Mr Richards is a full member of the British Association of
Aesthetic Plastic Surgeons (B.A.A.P.S) and the British Association
of Plastic Surgeons (B.A.P.S) as well as a being a Fellow
of the Royal College of Surgeons (FRCS) and registered on
the specialist register of the GMC for plastic surgery.
Adrian Richards and Associates has a series
of clinics and accredited hospitals across the mid shire counties
and at 10 Harley Street London and offers a complete range
of cosmetic surgery and non surgical procedures using the
most advanced techniques available.
For further information or to find your nearest
treatment centre visit http://www.arandassociates.co.uk
or call the information line on telephone number (UK) 0800
3285743 for specialist and sympathetic advice.
Mr A RICHARDS MSc FRCS (Plas)
Consultant Plastic and Cosmetic Surgeon
http://www.arandassociates.co.uk
Suite 3, Samuel House
Chinnor Road
Thame
Oxon OX9 3
a_richard200@yahoo.co.uk
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