Is the mini lift the same as MACS?

Kimberlyf asks

Is the mini lift the same as MACS?

Hi Kimberlyf,

No. MACS is a type of mini-lift, but a mini-lift is not a MACS lift (BMW is a brand of a car, but a car is not a BMW.) Mini-lifts are considered facelifts that don’t include a formal necklift. Mini-lifts tend to work well for early jowling (sagging of the jawline.) The S-lift is a type of mini-facelift which does not extend the incision behind the ear. The MACS lift is a type of S-lift which uses the same incisions as the S-lift. It lifts the muscles vertically using two loops of sutures (surgical threads) and anchors these loops to the chewing muscle of the temples (temporalis muscle.) If you look at the diagram, the “extended MACS-lift” version can lift up the cheek can improve the midface and lower face. You can see the third loop of suture close to the eye, looping down to the yellow oval (which represents the cheek fat which is lifted upwards.)

Why do they do that? Anchoring these sutures to this muscle seems to “slip” less than anchoring the suture to the tough outer coating of the extension of the cheek bone (periosteum of the zygomatic arch.) This seems to give the MACS-lift a longer lasting lift than the S-lift, according to the developers of the MACS (I don’t believe everything that I read, and neither should you.)

I have performed the MACS lift on a few patients, but I do not have their permission to show their photos. I googled: MACS-lift and Dr. Barry Press in San Jose seems to be a MACS-lift surgeon. Looking at his website, he visited the developers of the MACS-lift in Belgium before he started performing them in the states.

Let’s look at his before and after photos from his website. (Disclaimer: I do not know Dr. Press; I am not endorsing him, and I have no financial affiliation with him.) He has consistent before and after photos with the same face and neck position, his patients are not smiling, and he has lined up the photos nicely, which makes it easier for people to look at the improvements or lack of improvements. We could probably assume that these three examples are probably the best three MACS-lift patients that he has permission to show.

Patient 1: MACS-Lift, liposuction of the neck, bilateral lower lid pinch
blepharoplasty, bilateral upper lid blepharoplasty
Left: preoperative, Right: postoperative at 3 months

If we ignore the improvements from the upper and lower eyelid surgery and focus on the cheeks, smile lines, marionette lines, jawline and neck, what do we see? How much improvement is there in the neck profile? the cheeks? the smile lines? marionette lines? and finally the jawline?

No doubt there is some improvement in these areas. But it is still early at 3 months so most likely the face will relax a tiny bit more.

Here is an excellent result by Dr. Press, but at the same time we can see the initial improvement that the mini-lift does for the neck, as well as the later “rebound” of the muscle bands (look at the profile view on the second row of photos. You can see how angled her neckline is at one week, but in the 11 month after photo, the neck is not as angled as it was at 1 week, because of a partial return of the muscle bands. The good news for the patient is that from the front and angled view the muscle bands are not easily seen as compared to the before photo.) Also, notice how the swelling of the face at one week also makes the patient look like she is about 20 something years old. He uses this to show the viewer that the recovery from the MACS-lift is reasonable, but he also shows the final result, in order not to mislead the viewer into thinking that this is the final result.

Patient 2: Procedure: Endoscopic brow lift, Extended MACS-Lift, Suction assisted lipectomy of neck, SMAS grafts to upper and lower lips to increase fullness.

Photographs:Left: preoperative, Center: one week postoperative, Right: 11 months postoperative

Lastly, he shows another excellent result which is 18 months after the facelift, where the MACS and the liposuction did improve the neck profile.
Patient 3: Operation: Procedure: MACS-lift, submental/neck liposuction
Photographs: Left: preoperative, Right: 18 months postoperative

Why did MACS-lift work for the neck for the third patient, but not the second patient? Patient selection. The second patient clearly had strong muscle bands (platysmal bands) while the third patient had extra skin and fat. Since the liposuction took care of the extra fat, and the MACS got rid of the small amount of extra skin, she got a good neck result.

I like all three results, the incisions in front of the ears look good, the tragus looks normal, no pixie ears, and all three patients have nice overall improvements to the face. I think that we can be confident that all three patients are happy with their results.

My thoughts on MACS and mini-lifts.
(Disclaimer: These are my observations and experiences with the MACS and mini-lifts only, other plastic surgeons may have different experiences and results from the same types of lifts, so they continue to perform them. Based on my own patient experiences, I have decided to not offer them as my primary type of facelift. My views are biased towards performing the corset platysmaplasty, because I have had reproducible and reliable results with minimal problems. Not all surgeons believe in this procedure, but since I am getting good results and happy patients, I am not necessarily willing to try their technique as they may not be willing to try my technique. Take my views with a grain of salt, as you should with anything else that you read on the internet or mainstream media.)

In my experience, mini-lifts do not tend to change the neck profile, unless some liposuction is performed. If there is an improvement in the profile, I found it to be subtle, like in patient 1. If liposuction is performed too aggressively in the another problem can occur. Dr. Kamer wrote a paper regarding this problem called: Postoperative platysmal band deformity. A pitfall of submental liposuction F. M. Kamer and J. J. Minoli … /119/2/193

What can happen if the surgeon aggressively liposuctions under the chin, but does not look under the skin to see if there are muscle bands that need to be treated? I call it a cobra-neck deformity, Dr. Kessler calls it a Shotgun deformity. Same thing.

Shotgun Deformity
Over the last 10 years greater attention has been paid to the neck contour during facelifting procedures. In fact, a great majority of patients present to my office more concerned about their neck than their face. Current techniques allow greater manipulation of the deeper structures of the neck. If done well the results are excellent, if done poorly or in the wrong patient type, a depression immediately below the chin can be created. Instead of a soft curve in the submental area there is a central depression with fullness on either side. There is nothing natural about this appearance.

Early on, I saw that many of my own mini-lifts which had an initial muscle band/turkey neck improvement (like in Dr. Press’s patient 2), later fell or returned to close to its original position (<10% improvement.) When I gave them the initial consultation, I thought that the SMAS plication facelift should be able to hold the neck up. It did, but only for 6-8 weeks before it fell, to my dismay as well as my patients. This also happens to board-certified plastic surgeons in practice for 8-9 years as in TwinL’s case. I remember this because Barbara741 (my patient) and TwinL both had their necklifts around the same time this past March. In both their cases, the necklift/platysmaplasty was not performed with their original facelift. In order to maintain my reputation, I offered the patients with fallen necks free touch-up necklifts to “stand by my work.” The necklifts involved a corset platysmaplasty, and revision of the incision behind the ears. I did not have many pixie ears, but I did have some bad neck scars, which I was able to remove when performing the formal necklift. In order not to have Falling Necks, Pixies Ears & Thick Neck Scars, at least in my hands, I can’t rely on the facelift to hold the neck up. So, I perform a straight forward necklift (first liposuctioning the fat, then looking for the muscle bands to sew them together to prevent any muscle bands from reforming in the future.

Although I offer mini-facelifts as an option, I rarely find the right patient to offer it to. Most of my patients are over 50, if I had more patients under 50 then maybe I would find more good candidates for this procedure. The ideal patient for the mini-lift has mild jowling with an absolutely perfect neck profile with a minimal loose neck skin(<5% of my patients.) And for those patients, I recommend that they wait a few years before considering a facelift. There is some synergy to performing the facelift and necklift at the same time instead of separately, which is why the older established surgeons do not like to perform mini-facelifts, they turn away younger patients and let things sag at least a little bit more before performing the lift. (Kimberlyf this may pertain to you For the remaining 95% of patients, even the younger patients if they have early jowling, they usually also have early neck muscle bands or a single flap of skin and fat in the middle (turkey neck.) Since I do not want to make every facelift a two stage procedure, I offer a traditional extended SMAS lower facelift and full necklift, but under local anesthesia (which I named the Millennium Lift.) I have tried to go deep plane under local anesthesia, but it is too uncomfortable for the patient, so the most that I can do is an extended SMAS (which has about a 10% touch up rate). Since I can also perform a deep plane facelift, which I consider the gold standard for lower facelifts (touch-up rate of 3%) I price the extended SMAS facelift lower than my Deep plane facelift (which is riskier to the facial nerve and takes longer because I don’t want to rush when I am operating close to the facial nerve.) And my SMAS imbrication facelift (mini-facelift) is less expensive than my standard facelift (Millennium Lift.)

Small-Medium-Large Facelift Recommendations.

When people get clothes in stores, most people are mediums, fewer people are smalls and larges. This is called a Bell Curve distribution. … _questions

I think most surgeons offer as their standard facelift either a SMAS or extended SMAS facelift with proper necklift, which I think is a good fit for the majority of patients looking for a lower face and necklift. However if they only offer a mini-type lift they may still have a high satisfaction rate of 4 out of 5 patients, but if 1 in 5 patients (According to Dr. Kamer’s comparison of his own SMAS plication, extended SMAS, and Deep plane experience) request a touch up this creates a large number of unhappy patients which is bad for my reputation.

If you are getting facelift incisions on the sides of the face for a mini-lift or short-scar facelift, then there will be 4-6 inches of incisions per side of the face (8-10 inches total), what’s another 1″ incision in a wrinkle under the chin to get the proper neck work done? That adds up to 9-11 inches worth of incisions instead of 8-10 inches. Let’s at Hildy’s album again, ( … bumid=4436 ) notice she has a small tape under her chin for the necklift. Granted that her facelift is only one month old, but because the platysmaplasty was performed in the front of the neck, I am not worried for Hildy that her neck will fall.

I don’t necessarily agree with performing a deep-plane facelift on everybody either, especially if they don’t have very much to lift, their cheek position is fine, or are very fearful of a facial nerve paralysis. According to some comparisons of SMAS versus deep plane facelifts, only the older patients (over 65) does the deep plane facelift seem to be noticeably better than a SMAS. So if they have a deep-plane facelift as their first facelift when they are young, it would be more difficult to go deep-plane again for their second facelift, and instead a SMAS tightening (imbrication) procedure would be the better option for their second facelift. The problem that I would worry about is that when they are older they would benefit more from the the deeper facelift than when they were younger, so why use the deep plane facelift so early, unless they know that they won’t have a second facelift, and they should get as much done the one time as possible. Why use your Ace when a Jack will win the hand? Use the Ace later?

I did not want to offer either extremes of facelifts, because I think it would either be too much or too little for my patients. Therefore, thinking in a logical way, I feel that the extended SMAS facelift with a proper necklift should “fit” the center of the Bell curve the best and be suitable for most patients. If they are a better candidate for either a mini-lift or a deep plane facelift, I would recommend the best suited type of facelift for them.

Hopefully this small, medium, large strategy, full disclosure on the tuck-up percentages, numbness of the face, risk of facial weakness/paralysis, and standing by my work, will make all of my patients happy. I know that making all of your patients happy is not necessarily possible, but I think it is a goal worth striving for.