I'm confused, what exactly is a SMAS face lift, and a MACS?

Thank you for your question.Both are well described techniques of facelifting.The SMAS refers the the deeper muscle layer that needs to be lifted in facelift surgery.  Both techniques will address the SMAS but in a different fashion.The advantage of the MACS facelift is that there is a smaller scar behind the ears.  The SMAS lift is a plication and mostly a vertical lift.The SMAS lift is a slighlty longer scar yet it allows the surgeon to also undermine and lift the SMAS, in 2 and sometimes 3 vectors/directions, a more powerful manoeuver compared to most plication.The SMAS facelift is a slightly more tedious procedure but I find it a more powerful and longer-lasting procedure, in my hand.More important than the technique is to find an experienced board-certified plastic surgeon.Hope this helps.



Warmest regards,



Marc DuPere, MD, CM, FRCSC

This is a great question.  These are different surgical techniques that are use to lift the neck and possibly cheek region. Lets first discuss a SMAS lift facelift.  During any type of proper facelift, the deep layer of the face is tightened to lift the face.  This deeper layer is called the SMAS.  During a SMAS faceflift the SMAS is lifted in a vertical direction in the cheek region and horizontally in the neck region.  The SMAS is secured by multiple single stitches.  During a MACS lift, the SMAS is lifted by 1 or 2 continues stitches.  These stiches are tied tightly to bunch the SMAS together to give the face a lift.  A MACS lift is typically more veritcal in nature and does not require many incisions behind the ear.I preferentially perform SMAS facelift as I believe I get a better result with the technique.  I hope this helps.  

The best type of facelift for facial aging is one that produces consistently good results. Usually a SMAS lift where the muscle is tightened as well as excess skin removed produces better results. Choose a surgeon who is very experienced and consistently does natural looking faces for the best results. Do not rely on imagery. 

Part of the artistry of facelift surgery is creating surgical scars that are minimally visible or even invisible, while avoiding distortion of the normal anatomy around the ears. Incision placement and ultimate scar location in front of and above the ears is a critically important part of achieving an aesthetically ideal and natural-appearing result. The decision regarding placement of the temple-area scar above the ears should be based on the amount of upper / lateral cheek skin that is expected to be removed. If there is fairly minor skin laxity and minimal skin excess in this area, then the scar can be placed behind the temporal hairline (well behind the sideburns). If there is not much skin excess to advance in a superior/lateral direction, then the sideburns will not be rotated to any significant degree laterally (towards the ear) and will be preserved. If, however, an incision is made behind the temporal hairline and there is significant skin laxity and excess that must be removed, then the sideburns may have to be removed as part of the skin excess anterior to the ear. This produces a permanently disfiguring facelift result. An obvious and unmistakable sign of a bad facelift is the missing sideburn. In order to avoid a ‘sideburn-ectomy’ in a patient with significant facial skin laxity, the incision should be placed along the temporal hairline to avoid rotating the sideburns posteriorly and removing them along with the skin excess. The removal of skin excess is performed anterior to the sideburns (as well as in front of and behind the ears) so that the position and pattern of the sideburns remain unaltered. A number of ‘finesse’ techniques allow the creation of surgical scars along the borders of the sideburns that are essentially invisible in most patients. In the MACS lift, little to no skin elevation and redraping are done behind the ear – the surgeon attempts to remove all skin excess in front of the ear and at the sideburn. This frequently leaves significant skin contour irregularity around the sideburns and tends to produce more noticeable sideburn-area scars. Look closely at this area when reviewing a surgeon’s photos if they are recommending a MACS lift to you. Also carefully evaluate the neck and the area below the ears, as MACS lifts do not redrape excess lower face and neck skin behind the ear and therefore frequently leave contour irregularities here as well. The decision regarding incision placement requires careful preoperative evaluation and a great deal of experience with facelift surgery. In general, younger patients with less skin laxity are good candidates for incisions placed behind the temporal hairline, while older patients with greater skin laxity are often best served by incisions along the temporal hairline that preserve the sideburns. How ‘significant’ the facial skin laxity is, and to what degree the sideburns might be rotated posteriorly with an incision placed behind the temporal hairline, is an important judgment call each surgeon must make for every facelift surgery patient. It truly is part of the artistry of facelift procedures. Make sure that you seek treatment from a board-certified plastic surgeon with experience in this area and who can show you a large number of ‘before and after’ photographs which demonstrate natural-appearing and aesthetically desirable results, particularly in terms of sideburn preservation, minimally noticeable to invisible surgical scars, a lack of distortion of ear shape and position, and smooth skin contours in the anterior and lateral neck.

Smaller procedures including  MACS (Minimal Access Cranial Suspension) Facelifts which may be beneficial in the appropriate patient may have slightly
shorter recoveries, but also generally have shorter lasting results. The MACS lift involves a shorter incision, more vertical correction, and  less precise correction of the underlying tissue of the cheek which is called the Superficial Musculo-Aponeurotic System  (SMAS) The
exact technique is far less important than having the procedure performed by an
experienced, excellent artistic plastic surgeon who individualizes the procedure based on your anatomy and desired outcome.It is important to realize
that following the advice from a surgeon on this or any other website who
proposes to tell you exactly what to do without
examining you, physically feeling the tissue, assessing your desired outcome,
taking a full medical history, and discussing the pros and cons of each
operative procedure would not be in your best interest. I would suggest you
find a plastic surgeon certified by the American Board of Plastic Surgery and
ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS)
that you trust and are comfortable with. You should discuss your concerns with
that surgeon in person.Facial rejuvenation needs
to be individualized. What would be an ideal approach for one patient is not
necessarily the same for someone else. Based on the examination and discussion
at the consultation, you should have a better understanding of the various
options that can achieve the best cosmetic result for you.Robert Singer, MD FACSLa Jolla, California

As a consumer, it is much more important to pick your facelift surgeon based on their natural results, rather than trying to pick a specific type of facelift maneuver. There are many variations of both of these type of facelifts which is too technically difficult to explain due to the  intricate anatomy of the face. Basically  an MACS gives more of a vertical pull and an SMAS  facelift involves tightening the superficial muscular aponeurotic system on the cheek area to give mostly vertical and partially horizontal lift. For many examples of SMAS face lift results, please see the link below

As I've said aver many years do not pick a technique pick an experienced surgeon who can show you consistent results following a facelift in patients who look like you. Having said that, depending on your needs, I  usually recommend a SMAS lift which gives a more natural longer lasting result.