Can poorly placed MACS lift/ facelift scars cause skin sagging or is this due to tissue damage? Loss jawline definition. (photo)

I had a MACS lift 19 months ago. Surgeons i have since since have commented that the scars are very poor quality and too far forward. The scars are obvious and run in a long straight line some way in front of the ear rather than in the 'curve'. After swelling subsided tissues seemed slacker and jawline less defined. Its as if the tissues are no longer sitting in the right place. Could badly placed scars be the cause or is it due to tissue damage / tension. 1st pic is 'before' 2nd two 'after'

Doctor Answers 14

Bad facelift scar.

The scar may be able to be revised and the scar put inside the ear which has been the way I have done this for 35 years. This will not be possible if there is too much tension. The scar probably can be removed however. See an experienced facelift surgeon and go over the pros and cons of what can be done.

Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 32 reviews

MACS Facelift Scars

I'm sorry you are experiencing this. Your situtation can be helped. You need to find a plastic surgeon with experience in facelift revision surgery.

In a short scar facelift such as the ‘S-lift’ or ‘MACS’ lift, the skin excess removal is transferred from behind the ear to the area in front of the ear at the visible edge of the temporal hairline (sideburn), where it is much more challenging to deal with significant skin excess in a manner that is aesthetically acceptable. The excess is generally gathered around the sideburn area, leaving a wavy, pleated scar in a very visible location. The result one should be attempting to achieve in facelift surgery includes scars that are difficult for even a hairdresser to locate. Irregular scars in the sideburn area are a dead giveaway that a patient has had a facelift.

The reality of the ‘short scar’ facelift is that if one is talking about visible scars, then the scars aren’t any shorter than those that are created by a surgeon using expertly-planned and carefully performed traditional facelift incisions, and they tend to be more easily visible as skin excess is treated in front of the ear and sideburn.

Limiting the skin excision to the area in front of the ears and sideburns also creates problems in the neck. Look at numerous ‘before and after’ photos of patients who have undergone ‘short scar’ facelifts. In the patients who have jawline and neck skin excess preoperatively, you will almost always see unnatural appearing vertical skin folds in the lateral neck below the ear, and limited improvement in the definition of the jawline and neck in profile. If a facelift surgeon does no work with the skin behind the ear, then he/she severely limits their ability to improve the skin contour of the lateral jawline and neck.

The proof is in the pictures. Look at as many ‘short scar’ before and after photos as you can before proceeding. And check to see if the surgeon is using their patients’ hair - especially the sideburns - to conceal their patients’ pre-auricular (in front of the ear) scars.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 113 reviews

Unhappy with MACS lift

Thank you for your question about your face lift.

I am sorry you are disappointed with your result.
  • It may be possible to revise these scars.
  • I have seen this problem with other MACS lifts - 
  • this face lift relies entirely on very tight sutures which distort underlying tissues.
  • As the suture pull subsides, tissues shift.
  • So you may be correct that the tissues no longer seem to be in the right place/
Always see a Board Certified Plastic Surgeon.
Hope you find this information helpful. Best wishes.

Poor scars after a facelift are unacceptable.

A properly executed facelift should yield scars that are nearly invisible. I would expect your plastic surgeon to revise the scars as soon as is practicable.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 32 reviews

Please see a board certified Plastic Surgeon specializing in facelifts.

I am sorry your results did not turn out as well as you had hoped for.  The step for you would be to get a proper assessment by a board certified plastic surgeon, as looking at just your pictures does not allow for a full examination and assessment.

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 416 reviews

A Good Facelift Never Pulls Skin

The MACS lift relies on sutures deep in the SMAS to pull up the architecture of the face.  Unfortunately, I find that it doesn't hold up very well.  I think I did it 4 times and then abandoned it for reasons you are describing.  I suggest a complete re-do using sound surgical concepts instead of the gimmick.
Sometimes the "minimally invasive" techniques that promise just a little something - no major surgery, are a bad idea.  In my practice, I ALWAYS elevate and advance the SMAS because if I don't, the results don't seem to last.  Then I did all that work for nothing!
Good Luck!

Thomas P. Sterry, MD
New York Plastic Surgeon
5.0 out of 5 stars 17 reviews

Revision Facelift needed

Dear poppy7, Unfortunately your facelift incisions are to far forward and should have been placed into the hairline and inside the ear to avoid any visible signs of facelift surgery. Laxity is avoided by properly undermining the flap and suspending the tissues in the proper direction. The good news is that this may be fixed via revision facelift surgery. Have some consultations with experts in the field of revision facelift surgery. Revision surgery in the hands of an expert will allow you to have incisions that should be barely visible to the human eye under examination. During the procedure the surgeon will also address your laxity issues allowing a more defined neck and jawline. Best regards, Michael V. Elam, M.D.

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 196 reviews

MACS Facelift sorrows

Dear poppy7:

Various options for facelifting are available according to the skin laxity, soft tissue sagging and areas of lift or tightening you wish or need.

Generally, the more skin there is to remove and tuck, the longer the incision. If the incision is shortened, the excess bulge of the skin will redrape downward and may explain the " slacker tissues and less defined jawline" you have questioned about.  The more soft-tissue and fat lifting required, the more skin (flap) needs to be elevated  in order to reach and suspend these tissues.

The recent resurgence of the S-Lift (created in the early 1900's), has been modified into a 2 layer lift and called by other names as the Quick-Lift, Lifestyle-Lift, Swift-Lift, Soft-Lift, MACS-Lift and others. They are a single modification of the S-lift targeted to elevate sagging lower cheeks jowls and lateral upper neck. The shorter scar, limited undermining and second layer lift achieve the "quicker" procedure but not necessarily the quicker recovery or the improvements you desired.

Thank you for sharing your photos. The scars noted are a variation of technique that do not do justice to hiding them behind the tragus (cartilage protrusion in front of the ear canal). A longer incision properly placed behind the ear will assist in redraping the excess skin left along the jawline. Undermining the neck and placing a suspension suture across the neck (with or without neck platysmaplasty) will help to suspend the soft tissue descent of the neck and provide a crisper appearance. 

All of these concerns may be re-addressed with your surgeon or a 2nd opinion with a well experienced Board Certified Plastic Surgeon or Facial ENT. 

I hope this has been helpful! All the best!

Dean P. Kane, MD, FACS
Baltimore Plastic Surgeon
4.8 out of 5 stars 69 reviews


Thank you for the photos and your questions and the good news is that with a revision the scars should be able to be hidden and the skin tightened along your jawline.

Dr. Corbin

Frederic H. Corbin, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 58 reviews

Revision MACS

since you are not satisfied with the results and your scars, you might consider a revision at this time. Either return to your surgeon or have your face evaluated by a board certified facial plastic surgeon with experience in revisions.

Suzanne Kim Doud Galli, MD, PhD, FACS
Washington Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

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.