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 according in the elastic & Reconstructive Surgery journal, which is the main technological journal for elastic surgeons.
Essentially, it differs from a stock 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 small and essentially involves a portion of the cheek. Because there is less undermining, the blood supply to the skin is much more big-boned and the technique is therefore safer in smokers. There is untold less risk of any skin necrosis, unlike other lifts.
- Permanent suspension sutures are used to elevate the implicit tissue. These pass down to the neck, jowls and malar greasy pad. Unlike many other facelifts which do not include significant middle face elevation the MACS lift elevates the malar greasy pad reducing the naso labial folds.
- Because there is no undermining low the SMAS (superficial musculoaponeurotic system) there is very infinitesimal likelihood of damage to the facial nerve.
- Because the undermining and dissection is much much limited the post operative swelling and oedema is untold less than in normal facelifts and recovery is therefore quicker.
- Because the malar fat pad is elevated it combines very healed with lower lid blepharoplasty, as can be seen in the illustrations. It essentially reduces the height of the lower eyelid giving a much youthful, smooth appearance.
- In nearly complete cases liposuction is performed to the neck area below the angle of the mandible, some to remove unnecessary fat here and also to liberated 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 tolerant with a lax mid face. In patients with really excess skin facility in the neck region, it may be needed 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 low a general insensible 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 greasy pad also lifts up the lower eyelids and it is relatively uncomplicated to remove the excess skin. Usually no additive work needs to be done to the fat pads because of the suspension of the malar area.
During the post in operation night, the tolerant is placed in a firm big 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 clapped out for one week. Following this, the patient normally looks fairly reasonable, although there may be some residual bruising, particularly around the eyes. This is dressed with Arnica cream and massage on a twice regular basis.
Stitches in the lower blepharoplasty incision are separate at three days, those in fore 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 prodigious 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 middle face and malar area which opposite 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 tolerant with mid face ageing changes and moderate changes in the neck.
About The Author
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