MACS Vs. PSP Facelift?

What's the difference between an MACS lift and a PSP facelift?  Are these procedures like a mini facelift?

Doctor Answers 8

MACS vs. PSP facelift

Hello Susie,

First it should be noted that these two procedures have many things in common and that the differences are primarily technical in nature. They are a little more extensive in nature than my definition of what a "mini-lift" is but they are not as extensive as a Composite / Deep Plane facelift.

MACS: this stands for Minimal Access Cranial Suspension

PSP: this stands for Platysma SMAS Plication

1. Both are facelift procedures meant to tighten and elevate the SMAS and to remove extra / loose skin

2. Both are meant to improve the appearance of the lower third of the face (ie. jowls)

3. Both can be done with local anesthesia or IV Sedation

4. Both have similar risks associated with all facelift surgery

1. The MACS elevates the SMAS using a "purse string" suture that is deeply anchored to tissues overlying the cranium (the part of the skull in front of the ear)

2. The PSP elevates the SMAS by folding it onto itself and suturing it - much like sewing on a cuff onto the bottom of a pant leg (this technique is called Plication). The PSP also plicates the platysma muscle which is an extension of the SMAS that goes along the jawline onto the neck.

3. The PSP may have more impact on the neck due to this extended plication of the platysma in the neck

4. The MACS has an incision that is limited to the front of the ear and is best for people with mild to moderate signs of aging

In my personal experience, I feel that Cranial Suspension is a superior way of elevating and anchoring the SMAS. It has been my experience that with Cranial Suspension I am seeing longer lasting results than in Patents that I have performed Plications on in the past. In Patients in whom I perform MACS that also have a "turkey neck", I will also perform a Platsmaplasty or Neck Lift.

It is good to see you asking questions - please continue to do so with your Surgeon and ask for as many details as possible about each technique and why they feel one would be more suitable for you than the other.

Also speak with former Patients who have had either procedure over a year ago so you can get an idea from them of their satisfaction level.

All the Best,

Dr. Jafri

New York Facial Plastic Surgeon
5.0 out of 5 stars 11 reviews

Many facelift techniques produce similar results

Dr. Jafri's answer is excellent and answers your question in some great detail. I am responding to your comment. Most surgeons get experienced with a specific type of facelift and usually perform one or two types of facelifts. Some surgeons feel that one type of facelift procedure is far superior to another. Similarly, other surgeons feel that another technique is superior, and so on.

Years ago, our society did a study where facelifts were done on twins. One surgeon would do one technique on one side of the face and another surgeon would use a different technique on the other side of the face. Ten years later, the patients were reexamined and the results are impressive.

What we have learned from the "twin studies" is that one technique is in fact NOT superior to another. Ultimately, a deep plane/composite technique, SMAS lift, PSP, or MACS lift all look similar!! A lot of surgeons actually agree with the results of this study.

In terms of cost, there is usually no difference in pricing between a MACS and a PSP or a SMAS lift. It really just depends on your particular surgeon and what they charge.

Sirish Maddali, MD
Portland Plastic Surgeon
2.0 out of 5 stars 1 review

Difference between MACS lift and PSP lift

It is hard to describe the differences in words, but Dr. Jafri has done an outstanding job of it.

To illustrate the differences and simulate this for yourself using an oversimplified technique:

PSP lift: take your left hand and place it palm side down and flatly against your left cheek then pull your facial skin up towards your ear and the neck skin behind your ear.

MACS lift: take you left hand and with your thumb against your cheek bone in front of your left ear, gather all the skin on your left cheek with your fingertips and pull it towards your thumb. When done your should have pulled a circle of cheek skin in your finger tips.

I hope this helps to explain the difference.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

Branded minilifts

These are minilifts that can sometimes produce nice results but the longevity of them will not be as good as a true SMAS facelift. The reason is that a minilift doesn't truly release the deeper tissues to reposition them. They are mainly pulled on and are more prone to relapse. The other problem with the MACS lift in my opinion is the vertical pull on the skin it promotes. Pull straight up on your skin in front of your sideburn area and ask if that looks natural. I think it doesn't.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Facelift techniques

Many of these names facelift techniques are very superficial procedures that do not last. A MACS lift is an Ok procedure that basically uses suture plication to give a lift.  A PSP facelift is another form of mini-facelfit.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Chose the Surgeon not the Procedure

Given the increase in variety of Facelift techniques, and the branding of procedural name, confusion is to be expected among prospective patients. However, a "branded procedure" doesn't change the fact that outcome is much more related to the training, judgment, and skill of the surgeon involved.

My advice: see a local, well respected board certified Facial Plastic Surgeon or Plastic Surgeon and follow his/her advice.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 93 reviews

MACS and Mini Face Lifts

These are all varieties of mini face lift.

You have to understand the difference between a full face lift and a miniface lift.

What a miniface lift would address and what it would not address. Once you understand these detailed differences you will not be disappointed and make your decisions intelegently based on information.

Choose a board certified PS.

Samir Shureih, MD
Baltimore Plastic Surgeon
4.2 out of 5 stars 7 reviews

Technical nuances

These are just technical nuances described by surgeons and should not affect the patient’s choices. What matters is that a patient finds a facial plastic surgeon that they can trust. It would be wise to review 15 to 20 before-and after-photos of the surgeon’s work to measure consistency in results.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 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.