MACS Facelift Without Including Under Eyes?

I'm just about to have a MACS Face lift. But the doctor told me he won't do under eyes surgery as well. Is it ok? Can the results be just as good?

I was told once that it was much better to do both at the same time. I'm worried about puckering under my eyes afterwards.

Doctor Answers 14

MACS Facelift without including under eyes?

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In looking at your photograph I believe you would do very well with a MACS lift.

You are right to question the seeming illogical exclusion of the lower lids.

The MACS lift includes lifting of the face with 3 O-shaped sutures which elevate the sub skin structures where they belong. In so doing, as the tissues are lifted, the skin is moved up with them creating an excess in front of the ear / side burn and the lower lid which must be trimmed away. Choosing to ignore such redundancy of the lower lid may result in a suboptimal result.

You really need to clarify this point, as well as how your surgeon plans to address your neck in this procedure.

Good Luck.

Peter A Aldea, MD, FACS

Memphis Plastic Surgeon

Facelift and Blepharoplasty

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You may certainly undergo concurrent facelift surgery and lower eyelid surgery. The MACS lift will definitely manage your lower face and jowls, but, if you are concerned with your eyes, it will not address this area at all. You may also want to ask your surgeon about the decent of your mid face when you have both decided on a plan for your lower lids.

Philip S. Schoenfeld, MD, FACS
Chevy Chase Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

MACS lift without a lower eyelid lift

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Dear cactus5555:

Thanks for sharing your photos. This is helpful.  Without a full in-person exam, I can only generalize. I see a woman with moderate thickness to your skin, 3 of the “5 Facial Folds”, mild rounding of the lower eyelids, full but slightly thinning lips, mild jowling and mild central neck fullness with no neck banding.

The “5 Facial Folds” are due to laxity of the facial soft tissues and skin creating a wave-like folding along the:

  1. eyes,
  2. naso-jugal (tear trough),
  3. corner of lip (not in this photo),
  4. marionette / jowl, and
  5. neck (not in this photo)

In my experience, the MACS facelift is best for those patients requiring a small or “booster-lift”, ie. younger patient with minimal skin excess or following a prior facelift with minimal skin redundancy. I do not believe you will best benefit from the “minimized” facelift and it certainly will not address the jowls and neck. It is limited in skin removal as well as limited in its undermining to properly redrape the skin around the nasolabial fold / corner of mouth / marionette fold and jowl.

Based on the one photo, I believe you would best be served with:

  1. A more traditional subcutaneous face and neck lift.
  2. High SMASplasty; a lift of the SMAS to the cheek line which lifts the soft-tissues under the skin including the jowl and platysma.
  3. No platysmaplasty needed but the neck would be lifted to maximize redraping of the neck, jowls and jawline.
  4. Neck suspension sutures to elevate your platysma hammock, create a crisper jawline and neck crease.
  5. Fat grafting to the lips and cheeks
  6. Consideration for your lower eyelids if the risk of ectropion can be avoided.
  7. ZO Skin Health skin rejuvenation with retinoids and hydroquinone.

I hope this is helpful! All the best!

Dean P. Kane, MD, FACS
Baltimore Plastic Surgeon
4.9 out of 5 stars 103 reviews

MACS Facelift Without Including Under Eyes

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Yes, it is possible to #combine an eye lift with a #facelift. In fact, I commonly recommend other procedures to go accompany a facelift, such as #blepharoplasty or a midface (cheek) lift, to name a few. The combination of multiple of facial procedures may create an optimal result.

The best procedure approach will be discussed in greater detail during your one-on-one #consultation. I invite you to visit to view a complete list of surgeries commonly performed. 
The first step is to seek a board certified plastic surgeon who is highly trained with your desired procedures. I also encourage you to look at before and after photos of the surgeons actual patients. Also, reading patient reviews of those who have had combined surgeries will be beneficial. Gathering all of this information will help you make a well-informed decision.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

MACS Lift?

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A MACS lift is a form of mini-lift that utilizes two suture loops in order to purse string the SMAS, followed by redundant skin removal.  Although the photo is limited to a frontal view, a SMAS lift or other form of mini-lift should be helpful in addressing your jowls and jawline.  Can your lower eyelids be addressed at the same time?  The simple answer is that they can technically, but your Surgeon may seem something in your examination which has affected his/her decision making.  My personal preference with addressing the SMAS (the deeper fibro-fatty layer) is to elevate and reposition it, a technique known as imbrication.  A MACS lift alone will not be very helpful for your neck and addition of volume to the cheeks would also be helpful.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 103 reviews

A MACS Facelift can be extended to improve the under eye area

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The MACS facelift can be extended to include the the tissues below the outer portion of the eye. This technique involves a vertical vector of lift and can result in some skin excess or bunching below the outer portion of the lower eyelid and temple which sometimes requires a small pinch excision of skin of the under eye region.

In some patients there is enough improvement with the cheek elevation, that lower eyelid surgery is not necessary at the same time. I recommend that you discuss the MACS technique in more detail with your surgeon, specifically, to give you insight about your lower eyelid concerns.

Edward Szachowicz, MD, PhD
Minneapolis Facial Plastic Surgeon
4.6 out of 5 stars 14 reviews

It Depends

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As a plastic surgeon who does many MACS-Lifts, I suggest that you consider an Extended MACS-Lift to correct your drooping cheek fat. A MACS-Lift alone will not improve that area. If you undergo an Extended MACS-Lift, there will probably be some excess lower eyelid skin which will result from uplifting of the cheek tissue and which should be trimmed at the time of surgery. If you decide to only undergo a regular MACS-Lift, you won't need to have the skin trimmed.

George Sanders, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 13 reviews

MACS facelift and eye lid surgery

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There is puckering that can occur with a MACS facelift. A traditional comprehensive face/neck lift with upper and lower blepharoplasty can certainly be done at the same time rather than going with a MACS facelift. These operations can be done separately or together; however, it is best to undergo one anesthetic rather than two, and one recovery period rather than two different recovery periods.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

MACS facelift and optimal result

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A MACS lift is a type of short-scar facelift. In the classic MACS lift, there is no under eye incision. There are however many modifications to the MACS lift.

One of the situations that can be encountered when performing a MACS lift is bunching. This can occur in the cheek or temple. The MACS lift can really lift the lower face and cheek, which can also cause an excess of skin in the under eye area. A lower lid incision may then be necessary to create a smooth contour to the lower eyelid.

Another modification is a small incision back by the hairline. This is done to remove excess skin from the neck that is not addressed my the standard MACS lift incision.

The idea of the MACS lift is to create a youthful facial appearance with as little downtime as possible. The operation is then tailored to meet the patient's individual needs.

Jennifer Levine, MD
New York Facial Plastic Surgeon
4.4 out of 5 stars 26 reviews

MACS Lift has no effect on eyes, Extended-MACS does

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Hola Cactus,

Congratulations on your decision to undergoe a MACS lift - based on the photo here - you appear to have the type of facial anatomy that can benefit from this effective facelift approach.

Let's be very clear about your lower eyes though - the MACS lift as performed and designed by Drs. Tonnard and Verpaele does NOT affect the lower eyes. The Extended-MACS lift does (in this version the skin flap is extended to the area close to the lower eye muscles and the lower eye can indeed look pulled).

Please be sure to sit down with your Surgeon again and ask what form of MACS lift he/she is doing and what you can expect based on your anatomy. Also ask why he/she is not doing anything for your lower eyes. Does he/she feel it is not necessary? Is there an anatomical risk of a poor result if they do a blepharoplasty surgery (lower lid surgery)? Do they feel you might be better off with a chemical peel or laser? Are they indeed doing an Extended-MACS lift where your midface and lower eyes will get some benefit?

One more point I would recommend (again based on this one photo) is to ask if they plan on doing anything for the area under your chin (open or closed liposuction). While the MACS can be very effective for the jowls / jawline, patients with fat under the chin end up not happy with how it looks after the procedure if nothing was done to address the area.

Ciao and Best of Luck,

Dr. Kamran Jafri

Kamran Jafri, MD
New York Facial Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.