MACS lift
- 1999 S-lift: purse-string suture suspension of sagging tissues under local anesthesia; modified in 2002 into the MACS (minimal access cranial suspension) lift (PMID 11994618).
- MACS technique: inverted-L preauricular incision with extension below the sideburn, limited skin undermining, two permanent purse-string sutures (vertical U and oblique O) woven into the SMAS and anchored in the deep temporal fascia at the helical crus; 88 patients over 20 months (PMID 11994618).
- Extended MACS adds a third malar purse-string suture; 557 procedures (183 simple, 374 extended): one major complication, minor complications 6% (PMID 17604708).
- Lower third of the face: indications and limitations (PMID 18922317).
- Optimising MACS results (PMID 16075351).
- Retightening revision of a prior MACS lift (PMID 20108092).
- Single-surgeon series, 80 MACS vs 8 conventional: MACS operative time 2:39 vs 4:03; 3 hematomas (3.41%) all in MACS; 3 MACS patients disappointed by residual skin laxity or neck contour (PMID 24691336).
- 2018-2024 practice of the originators, 380 MACS lifts: ancillary procedures in 98.9% (mean 5.8 per patient), lipofilling 96.3%, neck lift 67.9%, nanofat microneedling 64.7%; no major complications (PMID 40906287).
- Systematic review 2022, 6 studies, 739 patients: no major complications; high satisfaction; shorter operating time than conventional lift; limited effect on the neck (PMID 34922854).
- Meta-analysis 2026, 4 studies, 286 patients (MACS 186, SMAS 100): comparable aesthetic results and complications; MACS shorter (SMD 2.05) (PMID 41597398).
- ABPS tracer data: MACS fell from 10% (2006-2014) to 6% (2015-2021) of facelifts (PMID 38302713).
Short-scar SMAS lifts
- Baker, minimal incision rhytidectomy with lateral SMASectomy: 749 cases over 10 years; complication rates similar to standard techniques (PMID 19331867).
- Lateral SMASectomy, plication and short scar indications (PMID 18922307).
- Minimal access deep plane extended (MADE) vertical lift: deep-plane release through a short incision, 153 patients (PMID 22065880).
- Minimal access vs traditional access defined by incision size; candidacy maneuver described (PMID 23731580).
- Sub-SMAS facelift with no temporal incision, 225 patients: temporary neuropraxia 7.6%; 7% had a secondary facelift at mean 3.5 years (PMID 32309087).
Evidence on outcome
- Identical twins, randomized incision (full vs short scar), 4 sets plus 1 set of triplets: no difference at about 1 year; full incision scored higher in the neck at about 5 years (PMID 26890507).
- Limited incision facelift review 2024, 20 articles, 4,451 patients: overall complications 3.2%, hematoma 2%, temporary nerve injury 0.2%; 84% under local or conscious sedation; drains or sealants associated with 86% fewer complications (PMID 37950895).
- No-release lifting stretches retaining fibers and places the flap weight on the fixation sutures (cadaver study, 50 heads) (PMID 37747400).
History
- Suzanne Noel's "petit operation" defined principles used in the mini-lift and short-scar facelift: hairline incisions, limited incision length, low skin tension (PMID 31637506).
Glossary
- Short-scar facelift: facelift with a shorter incision to limit scar visibility (PMID 37950895); compared against the full incision in twins (PMID 26890507).
- MACS lift: minimal access cranial suspension; purse-string SMAS sutures anchored to deep temporal fascia (PMID 11994618).
- Purse-string suture: a suture woven in a loop and tied to gather tissue (PMID 17604708).
- Extended MACS: MACS with a third malar suture for the midface (PMID 17604708).
- S-lift: 1999 predecessor of the MACS lift (PMID 11994618).
- Limited incision facelift (LIF): umbrella term for short-incision approaches (PMID 37950895).
Papers
| PMID | First author | Year | Journal | Title | Finding |
|---|---|---|---|---|---|
| 37950895 | Amador RO | 2024 | Aesthet Surg J | Limited Incision Facelifts: A Contemporary Review of Approaches and Complications. | Limited incision facelifts review, 4,451 patients |
| 11994618 | Tonnard P | 2002 | Plast Reconstr Surg | Minimal access cranial suspension lift: a modified S-lift. | MACS lift introduced, 88 patients (landmark) |
| 34922854 | Hijkoop LF | 2022 | J Plast Reconstr Aesthet Surg | The minimal access cranial suspension (MACS) lift: A systematic review of literature 18 years after its introduction. | MACS systematic review, 739 patients |
| 17604708 | Verpaele A | 2007 | J Plast Reconstr Aesthet Surg | The third suture in MACS-lifting: making midface-lifting simple and safe. | Third malar suture, 557 MACS procedures (landmark) |
| 18922317 | Verpaele A | 2008 | Clin Plast Surg | Lower third of the face: indications and limitations of the minimal access cranial suspension lift. | MACS lower third indications and limits (landmark) |
| 16075351 | Tonnard PL | 2005 | Aesthetic Plast Surg | Optimising results from minimal access cranial suspension lifting (MACS-lift). | Optimising MACS results (landmark) |
| 20108092 | Tonnard P | 2010 | Aesthetic Plast Surg | Retightening revision of a previous MACS-lift meloplasty. | Retightening a prior MACS lift (landmark) |
| 24691336 | Mast BA | 2014 | Ann Plast Surg | Advantages and limitations of the MACS lift for facial rejuvenation. | MACS vs conventional: shorter time, laxity limits (landmark) |
| 40906287 | Sommar P | 2026 | Aesthetic Plast Surg | Use of Ancillary Procedures in Combination with the MACS-Lift for Facial Rejuvenation: A Retrospective Cohort Study. | 380 MACS lifts: 5.8 ancillary procedures per patient |
| 41597398 | Pandkhahi A | 2026 | Medicina (Kaunas) | Comparison of Deep SMAS Lift and MACS in Facelift: A Meta-Analysis. | Meta-analysis MACS vs deep SMAS |
| 38302713 | Stein MJ | 2024 | Aesthetic Plast Surg | Clinical Practice Patterns in Facelift Surgery: A 15-Year Review of Continuous Certification Tracer Data from the American Board of Plastic Surgery. | ABPS: MACS share 10% to 6% |
| 19331867 | Baker DC | 2001 | Aesthet Surg J | Minimal incision rhytidectomy (short scar face lift) with lateral SMASectomy: evolution and application. | Baker short scar with lateral SMASectomy, 749 cases (landmark) |
| 18922307 | Baker DC | 2008 | Clin Plast Surg | Lateral SMASectomy, plication and short scar facelifts: indications and techniques. | Lateral SMASectomy, plication, short scar (landmark) |
| 22065880 | Jacono AA | 2011 | Aesthet Surg J | The minimal access deep plane extended vertical facelift. | MADE vertical facelift (landmark) |
| 23731580 | Jacono AA | 2013 | Facial Plast Surg Clin North Am | The modern minimally invasive face lift: has it replaced the traditional access approach? | Minimal vs traditional access (landmark) |
| 32309087 | Swanson E | 2020 | Plast Reconstr Surg Glob Open | Clinical Evaluation of 225 Sub-SMAS Facelifts with No Temporal Incision. | Sub-SMAS lift without temporal incision, 225 patients |
| 26890507 | Antell DE | 2016 | Plast Reconstr Surg | A Comparison of the Full and Short-Scar Face-Lift Incision Techniques in Multiple Sets of Identical Twins. | Twins: full incision better in neck at 5 years (landmark) |
| 37747400 | Minelli L | 2024 | Plast Reconstr Surg | Anatomy of the Facial Glideplanes, Deep Plane Spaces, and Ligaments: Implications for Surgical and Nonsurgical Lifting Procedures. | No-release lifting and retaining fibers |
| 31637506 | Ritchie D | 2020 | Aesthetic Plast Surg | Contributions of the First Female Plastic Surgeon to Modern-Day Rhytidectomies. | Suzanne Noel and the short-scar principle |
Open questions / controversies
- Neck: short scar and MACS have limited neck effect (PMID 34922854); the twin study found the full incision better in the neck at 5 years (PMID 26890507).
- Durability of suture suspension without release (PMID 37747400).
- Comparative trials are few: 4 studies and 286 patients in the only MACS vs SMAS meta-analysis (PMID 41597398).
- MACS has become a platform for many ancillary procedures, so the effect of the lift alone is hard to isolate (PMID 40906287).