Procedures/ Minimal Access Cranial Suspension Lift


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Minimal Access Cranial Suspension Lift

A minimal access cranial suspension lift or MACS lift is a minimally invasive facial cosmetic surgery. It is used to correct signs of aging in the middle and lower thirds of the face and neck. Keep reading to learn more about this procedure, which is also called a modified S-lift, and see how it compares to other facial rejuvenation procedures.

Signs of aging in the lower face and neck

When you are young, in your 20s and 30s, your cheeks are full, the under-eye area is plump, and the temples are taught. With age, as you go into your 40s and 50s and beyond, there is loss of volume due to a decrease in subcutaneous fat (fat under the skin). This leads to a sagging of the facial tissues down towards the jaw and neck, causing formation of things like trough deformity and hollowing of the cheeks.

Deeper in the skin, the tissues also shift downwards. A layer of fat and muscles called the SMAS (superficial musculoaponeurotic system) droops down, creating what is commonly called jowls. Moreover, sun damage leads to the formation of fine lines, wrinkles, and marionette lines. The result is the mid and lower face and neck appear aged and tired.

A facelift can correct these changes that occur with time and age. The surgery pulls the sagging, drooping tissues back up where they belong. Surgeons use many different surgical techniques to accomplish this, including a deep plane or SMAS facelift, a mini facelift, an S-lift, and a MACS lift.

MACS vs older facelift techniques

MACS lift has been gaining popularity over the last decade or so because it is a gentler approach to facial rejuvenation. Compared to traditional facelift techniques, MACS lift short scar rhytidectomy is associated with less downtime and smaller scars, while still achieving permanent suspension of the delicate structures of the lower face and neck which tend to sag with age and time.

Lifting upwards vs sideways

One of the key disadvantages of older facelift surgical approaches is that the skin of the cheek is pulled sideways to tighten it. This can give the patient an overdone or unnatural look, which is usually referred to as a windblown appearance. In contrast, MACS pulls the tissues upward, resulting in a more natural facial rejuvenation.

Risk of facial nerve injury

Some older techniques involve manipulation of deep facial soft tissues, putting the patient at risk of facial nerve injury, paralysis, and permanent loss of facial expressions. Minimal access cranial suspension lifting, on the other hand, involves more superficial tissue manipulation, lowering the risk of nerve injury.


An older facelift technique can involve very long incisions in the hairline and behind the ear. A minimal access cranial suspension lift requires smaller incisions compared to other facial rejuvenation surgical techniques.

What does a MACS lift short scar technique involve?

MACS is short for minimal access cranial suspension. Minimal access means the surgeon only needs to make small incisions, which means the patient is left with shorter scars. The incision used in the MACS technique typically starts below the earlobe and extends upwards in front of the ear, up to the lower end of the sideburn, from where it extends forward in a zig zag manner for about 1 inch. This horizontal zig zag portion of the incision is well hidden in the sideburn. The incision in front of the ear is placed within a natural skin crease and fades within a couple of months to become unnoticeable.

After making these incisions, the surgeon lifts the SMAS (superficial musculoaponeurotic system) and permanently suspends it using a purse string suture at a fixed point in the cranium. The point of suspension is usually in the temporal area (near the temples at the side of the head). Therefore, the name minimal access cranial suspension lifting.

The surgery helps lift the jowls in the lower face as well as the corner of the mouth obliquely upward. Over time, the tissues heal in their new lifted position, giving the face a tighter, more youthful appearance. As noted, the results are more natural after a minimal access cranial suspension lifting compared to some other techniques that create an overdone look.

Some types of older facelift approaches require the surgeon to cut through the SMAS. This puts the patient at risk of facial nerve injury. A minimal access cranial suspension lift stays above the surface of the SMAS. This technique is, therefore, associated with a reduced risk of facial weakness and paralysis.

Advantages of MACS plastic surgery

Some of the key advantages of a minimal access cranial suspension facelift are listed below:

  • The procedure addresses the specific anatomy that is responsible for creating jowls in the lower face.
  • The scar is shorter and does not extend to the hairline or behind the ear.
  • A MACS lift directly counteracts facial sagging by lifting the tissues upwards. Older facelift techniques pull the tissues sideways, creating an overdone or wind-tunnel appearance.
  • There is a lower risk of injury to the facial nerve because the tissue manipulation is done superficial to the SMAS. Deep plane facelifts, in contrast, involve tissue dissection under the SMAS, which is associated with a higher risk of nerve injury and paralysis.
  • The procedure is performed under general anesthesia, so you are asleep during the surgery. The time taken to complete a MACS lift is less than other types of facial plastic surgery. The operative time is usually less than 4 hours, including preparation, anesthesia, and postoperative transport to the recovery room.

Recovery after minimal access cranial suspension facelift

Your surgeon will have you stay in the hospital overnight after a MACS lift. The dressings and drains are usually removed at the bedside the next morning before you are discharged home. You will go home with a comfortable chin strap that helps to support the repair and reduce swelling.

Finding a surgeon for a MACS lift

The MeTime app makes it easy to find experienced aesthetic surgeons in your area. You can click and upload pictures and have suggestions sent directly to you. Interested in finding out if a MACS lift is appropriate for you? Try the MeTime app now!

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