What is the difference of a Macs and SMAS Lift? (photos)

Thank you for your question.SMAS refers to the deeper muscle layer that needs to be manipulated and pulled for a longer-lasting facelift results.  SMAS stands for Superficial Musculo-Aponeurotic System.  The SMAS can be folded and plicated or can be raised as several flaps and pulled in various vectors, such as vertical, oblique and posterior vectors.  Please read the blog I am including in my answer.MACS stands for Minimal Access Surgery aka a short-scar facelift.  The SMAS is also treated but done so mostly vertically with a plication and thick sutures.  No flaps are raised.  The MACS is faster to perform, the underming is less and the scar is smaller.  Yet the visible scars are the same as the SMAS facelift in front of the ears.  The issues with any short-scar techniques is that there is a significant excess of skin in many cases that require multiple foldings behind the ears (skin is bundled up), especially in the older patients.  Those folds often disappear but it may take 6-12 months.Most plastic surgeons perform both.  MACS may work well in younger patients as the excess of skin is lesser and the required bundling of skin is less.But they are many situations where the SMAS won't shift up with plication alone (MACS) unless undermined and lifted so the SMAS facelift as originally described is a better option.  The ability to create 2 or 3 SMAS flaps allows multidirectional pulls, which i see as an advantage in many cases.Your plastic surgeon should be able to perform both and should be able to recommend the best technique for you.  Financial considerations are also important; the MACS may not be as powerful as the traditional SMAS facelift but it is also slightly less costly.Let us know if this information was useful.



Best regards,



Dr. Marc DuPéré, Toronto aesthetic plastic surgeon and facialist

Thank you for your question. MACS stands for minimal-access surgery, which I call a mini facelift or awake facelift in my practice because it is usually performed with local anesthesia rather than general. Incisions are smaller with this technique, so recovery and scarring are both reduced. However, the level of correction is often less dramatic, and I typically recommend this procedure to women who have mild to moderate aging symptoms.

A SMAS facelift stands for superficial aponeurotic system, which means the surgery works deeper into the tissue to create a more dramatic, yet natural, result. This procedure requires longer incisions and a longer recovery time, but also offers the most noticeable, long-lasting outcome. You can combine either of these facelift procedures with a neck lift to rejuvenate the area from the neck all the way to the midface. The peel after your surgery will refresh the skin and eliminate surface imperfections and aging signs the surgery will not correct. Make sure you are working with an experienced, board-certified facial plastic surgeon to ensure the best possible result.

MACS is a minimally invasive technique while a SMAS technique is more extensive and moves facial muscles.  Many people who used to do MACS are moving away from it as the results are not as long lasting