Hi Lagertha,A MACS lift is a type of mini-facelift and a modification of the original mini-facelift called the S-lift. The S-lift has a limited incision behind the ear and a longer incision in front of your ear, curving under the sideburn, in front of the ear, then under the earlobe for a couple of centimeters. This is shaped like an S, thus the name S-lift.For patients who are having a necklift only, the incisions are behind the ear and a 1/2"-1" incision under the chin depending on the surgeon's comfort level on keeping the incision small. I suspect that an S-lift type incision may not do enough to help remove skin for the necklift. A mid-facelift is not the same as a mini-facelift. The term midfacelift is actually a term used for a type of cheeklift which is performed endoscopically with an incision in the temple and additional incisions inside the mouth to release the entire cheek off of the cheekbone and reposition it in a higher position. With as smooth as your cheeks and smile lines are I don't think an endoscopic midfacelift is warranted. An extended MACS lift can lift the cheeks a bit, but it is not in the same class as an endoscopic midfacelift. A MACS lift alone would be considered a mini-facelift, and an extended MACS lift extends the incision in front of the hairline of the sideburn/temple in order to lift the cheek somewhat. Since there are no obvious signs of upper cheek sagging, I'm not sure if the incision in front of the hairline will provide enough of an improvement to warrant the extended incision. The vertical platysmal banding is the main reason for performing a corset platysmaplasty. I have tried depending on the SMAS tightening to treat the which did not work. Any initial improvement in the vertical bands with the tends to fade in about 3-4 months on average with a face tightening alone without using the corset platysmaplasty.For patients over 45 years old, a lower facelift and a necklift will provide the best results. Why? The incision behind the ear helps to tailor out the excess skin on the neck itself. The incision for the facelift will help smooth out the excess skin which may be excess or hanging under the chin. Without the facelift incision, excess skin under the chin may result in pleating or bunching of skin after the platysmaplasty, because there is no place for it to be tailored out.Your face looks very smooth, with no obvious smile lines and smooth high cheeks. The lower facelift will help with your mild jowling (sagging of the jawline). Other than that, the facelift will unlikely show much difference on a before and after photo other than the smoother jawline.As far as the local anesthesia question, I offer a procedure which is called a Necklift plus which is essentially a necklift with a mini-facelift to help tailor out the skin under the chin with the mini-facelift incision. This procedure is a full corset platysmaplasty under local anesthesia, but the lower facelift portion of the procedure is only a mini-facelift with SMAS tightening. I do offer a modified deep-plane sub-SMAS facelift with platysmaplasty, but I can only do that in the Surgery Center with IV sedation or full general anesthesia for the comfort of the patient in the Deep plane portion of the procedure. I am able to perform the corset platysmaplasty through a 1/2" incision under the chin, and with the retractor, and the elasticity of the skin the incision can stretch to about 3/4", which is enough of a keyhole to perform the surgery well.Of note, to ensure realistic expectations for patients who are seeking face and necklifts, the main goal is to lift and tighten the deeper layers (SMAS and platysma) to create a firm foundation. The skin portion of the procedure is to tailor out any excess skin so none of this skin is "hanging" or "sagging" off of the face and neck. The skin is not "drum tight," but only enough to not let the skin hang. This gives a nice natural result which is not showing any tension lines or windblown look. A face and necklift is a high satisfaction procedure, but cannot make an older neck actually become a younger neck. The skin quality has not changed, any sun damage and other accumulated aging does not get reversed by tightening the foundation and tailoring out excess skin. If the surgeon tries to removed too much skin, new problems can occur, such as a pixie ears, or thicken scars. Good luck on your face and neck improvement journey.Best,Dr. YangP.S. If you find my answers or other doctors answers to questions are helpful, please +1 those answers to push up the better answers to the top, which helps others who read the same post, get to the more helpful answers first.P.P.S. There is a new feature on Realself, which is the "Follow" button. It is similar to the "Like" button on Facebook. If you like my response or any of the doctor responses while you research on Realself, you should "Follow" them. You will get email updates, when the doctors you follow post any new answers to questions, post new photos, or have any new reviews.
