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MACS Facelift

MACS = Minimal Access Cranial Suspension

There are many types of minimal scar facelifts and the global trend in facial rejuvenation is increasingly toward minimally invasive surgery.

Those of you who have read my opinion piece on the philosophy of facelift surgery will understand my thoughts on facial rejuvenation in general and this article will explain to you why I use this technique. It was originally described by 2 surgeons in Belgium called Patrick Tonnard and Alexis Verpaele and has a number of principles which I think are important.

The major take home points are listed below.


  • A smaller scar
  • Less undermining of the skin
  • Dissection in a superficial plane immediately under the skin
  • Two or three sutures to suspend the fascia of the face (SMAS)
  • Supension of the face in a vertical dimension

In experienced hands a modified MACS gives superior surgical results.

The reasons I use this technique are –


  • It is safe with a very low rate of facial nerve injury
  • It has a smaller scar which is well hidden and preserves the normal hairline
  • The suture suspension gives an adequate suspension without being overdone
  • The vertical suspension is anti-gravity and makes sense

In my experience though it does have its deficiencies and so my personal modification of this technique is designed to address those issues. I believe the dissection in the safe plane does not go far enough so I extend the dissection further for a greater effect. The results I have seen presented in international meetings also don’t adequately address the neck and so my version of the MACS is more aggressive in lifting the neck to try and prevent secondary relapse of a drooping neck. Thirdly I nearly always use the midface suture which is the uppermost suture and addresses the cheek region. This also has a more pronounced effect on the flattening of the nasolabial folds. In my hands these modifications give superior aesthetic results.

This opinion piece was brought to you by Dr Damien Grinsell.