Summary
Background
The minimal access cranial suspension (MACS)-lift is a short scar rhytidectomy with
vertical purse string suture suspension of the facial tissues. It exists in a simple
and extended version. The simple MACS-lift achieves a vertical lifting of neck and
lower half of the face with two purse string sutures. The action of a third, malar
suture gives additional correction of the middle third of the face, and results in
the extended MACS-lift.
Objective
To draw attention to the power and advantages of the ‘third’ malar suture in the extended
MACS-lift in achieving volumetric restoration of the midface, softening of the nasolabial
fold and enhancing support of the lower eyelid.
Methods
The core principle of this technique is the use of strong purse string sutures in
a pure antigravitational direction for correction of the ageing neck and lower two-thirds
of the face. In a simple MACS-lift the neck is corrected by a first narrow vertical
purse-string suture. The volume of jowls and cheeks is repositioned in a cranial direction
with a second, slightly oblique purse string suture.
To achieve better control over the midface an extended MACS-lift is performed by adding
a third malar vertical purse string suture between the paracanthal area and the malar
fat pad.
Results
557 MACS-lift procedures have been performed by the two senior authors, of which 183
were simple and 374 extended. A retrospective review of this technique revealed high
patient satisfaction, only one major complication and a minor complication rate of
6%. Both versions of the technique deliver a vertical vector correction of sagged
facial features. The third suture restores the volume of the midface and malar mound
and provides strong support of the lower eyelid.
Conclusions
The third suture in the MACS-lift short scar rhytidectomy produces a natural midface
lifting through a short scar, with adequate softening of the nasolabial fold and good
support of the lower eyelid.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Plastic, Reconstructive & Aesthetic SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Minimal access cranial suspension lift: a modified S-lift.Plast Reconstr Surg. 2002; 109: 2074-2086
- The MACS-Lift. Short-Scar Rhytidectomy.1st edn. Quality Medical Publishing, St Louis2004 (pp. 69–166)
- Optimising results from minimal cranial suspension lifting (MACS-lift).Aesthetic Plast Surg. 2005; 29: 213-220
- A comparison between parallel hairline incisions and perpendicular incisions when performing a face lift.Plast Reconstr Surg. 1997; 99: 10-15
- Platysma suspension and platysmaplasty during neck lift: anatomical study and analysis of thirty cases.Plast Reconstr Surg. 2006; 117: 2001-2007
- Techniques to address the malar fat pad.Aesthetic Surg J. 2005; 25: 66-68
- Update: lifting the malar fat pad for correction of prominent nasolabial folds.Plast Reconstr Surg. 1997; 100: 715-722
- Minimal incision rhytidectomy (short scar face lift) with lateral SMASectomy: evolution and application.Aesthetic Surg J. 2001; 21: 14-26
- Subperiosteal minimally invasive laser endoscopic rhytidectomy: the SMILE facelift.Aesthetic Plast Surg. 1996; 20: 463-470
- Composite rhytidectomy.Plast Reconstr Surg. 1992; 90: 1-13
- Three-dimensional rejuvenation of the midface: volumetric resculpture by malar imbrication.Plast Reconstr Surg. 2000; 105: 267-285
- Facial recontouring with lipostructure.Clin Plast Surg. 1997; 24: 347-367
- Face-lift stigmata.Ann Plast Surg. 1985; 15: 379-385
- National plastic surgery survey: face lift techniques and complications.Plast Reconstr Surg. 2000; 106: 1185-1195
- Extended SMAS dissections as an approach to midface rejuvenation.Clin Plast Surg. 1995; 22: 295-311
- Commentary on minimal incision rhytidectomy (short scar face lift) with lateral SMASectomy: evolution and application by Baker DC.Aesthetic Surg J. 2001; 21: 14-26
- The ‘R.A.R.E.’ technique (Reverse and Repositioning Effect): the renaissance of the aging face and neck.Aesthetic Plast Surg. 2004; 28: 127-142
- The volumetric face lift.Aesthetic Surg J. 2004; 24: 514-522
Article info
Publication history
Published online: July 09, 2007
Accepted:
December 27,
2006
Received:
October 20,
2006
Identification
Copyright
© 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
