Why do doctors suggestion MACS Lift for a secondary procedure?

Question

I had a Sub Smas face lift. It is mild sagging skin around mouth and jowl which it is not successful. Why Dr choose MACS lift even it is last for 5 years after Sub Smas face lift? MACS lift may last for 5 years. Long Loop sutures is bothering me so much. Loop sutures can make ripple skin, uneven lift, bulge, ridge and etc. I compare MACS lift and M.A.D.E lift. M.A.D.E lift sound better and last longer because it is part of Deep Plane.

Donn R. Chatham, MD · Answer

While many versions of ‘facelift’ procedures exist, there is no perfect one. The MACS lift (Minimal Access Cranial Suspension Lift) remains a valuable technique in properly selected patients. Secondary facelift is one example.

Rohit Jaiswal, MD · Answer

Thanks for the question. 
For secondary facelifts there is added complexity to an already challenging procedure. This is because there may be significant scarring below the SMAS after the original facelift. This plane below the SMAS is very important since the nerves that control movement in the face are located around here. Therefore, trying to do a sub-SMAS lift for the second time can be quite difficult and perhaps more dangerous to the nearby nerves. 
For this reason, I usually perform either a MACS lift (called a mini-facelift by some) or a SMAS plication on secondary facelifts. This allows me to avoid opening up that scarred plane while also achieving a reasonable lift. I find the MACS to be a nice technique for elevating the lower third facial structures as well as the neck to an extent. 
Your surgeon may feel the same way, which is why he or she recommended the MACS for your secondary procedure. 
Best wishes, 
Rohit Jaiswal, MD 
Plastic Surgeon; Las Vegas, NV

Houtan Chaboki, MD · Answer

Without an office examination, it's difficult to provide specific recommendations. Mild sagging of skin around mouth may not be directly addressed with facelift surgery alone: MACS, SMAS, deep plane, etc. Revision facelift patients with mild perioral wrinkles can consider nonsurgical treatment directly in this area such as skin resurfacing (peel, laser, etc), Botox/Dysport, and fillers.Best,Dr. Chaboki

Robert M. Tornambe, MD · Answer

Jane.     Photos or physical exam would help to pinpoint your exact issues. In general however, MACS Facelift can last as long as 10 years, depending upon the exact technique used. You may consider obtaining a second opinion from a board-certified plastic surgeon, as your case seems somewhat complicated.  Best of luck.

Dean P. Kane, MD, FACS · Answer

Dear janejaney doe:

Thank you for this most interesting question!

The simplest answer to your question is “Surgeons (generally) perform what is best in their hands” based on talent, education and experience.

Beginning in 1901, an ellipse of skin in front of the ears called a “C” lifted the tissues of the sagging cheek. This quickly evolved to the S-Lift which was then adopted with the elevation of the deeper muscle tendinous tissues such as the SMAS (by Skoog) in the 1970’s and the Deep Plane (by Hamra) in the 1980’s.  Most recently, various surgeons have marketed their own “faster styled” facelift such as the  Quick-Lift, Lifestyle-Lift, Swift-Lift, Soft-Lift, MACS-Lift and now you have introduced me to the M.A.D.E. lift. I have explored Dr. Jacono’s website where he explains the M.A.D.E. lift as a “mini” deep plane lift whereas the MACS lift by Tonnard and Verpaele is a “mini” SMAS lift using looped sutures.

I find that most patients come in for a face and/or neck lift when facial skin excess occurs along the marionette fold and jowl or neck. If you can “pinch more than an inch” along the jawline, there is no non- or minimally invasive option to tighten the skin and skin redraping when excision of skin excess is required. Before that point in time or following a face and neck lift when there is less skin excess, a MACS or M.A.D.E mini-facelift may be helpful. Again, your point in aging, weathering, hereditary skin and many other factors will contribute to the duration of these lifts. Since the MACS lift is more superficial, you may see more of the skin rippling and bulging early on as you mention. The M.A.D.E. lift being deeper (I have no experience with this technique) may provide for a smoother early result.

Comparative twins studies of the MACS and Deep Plane techniques have found no difference in results nor duration.

Let’s not by-pass the newest evolution of minimally invasive techniques including:

ThermiTIGHT

Silhouette suspension InstaLift

Sculptra

As I started with this inquiry, this is a great question in the evolution of facelifting. There are many factors to consider for your individual desires so consider more than one consultation from experienced Board Certified, talented and skilled Plastic Surgeons and Facial-ENT’s for their evaluation and recommendations.

I wish you the very best!

John V. Williams, MD · Answer

Thanks for your question. After a Sub SMAS Face Lift there is scarring between the SMAS and the underlying deep tissue. There are facial nerves at different levels in this underlying deep tissue. Because of this scarring it may not be possible to see these nerves when the SMAS tissue is re-elevate, especially if the re-elvation is done in a deep place, and result in nerve damage. The MACS does not dissect the SMAS from the underlying deep tissue and therfore less risk of nerve damage in a secondary Face Lift.
In a SMAS Face Lift only the upper portion of the SMAS is sutured to lift the deep tissue.  In a MACS Face Lift a  continous suture places multiple sutures through the entire portion of the soft tissue being elevated so it is a stronger type of suture elevation.  In actuality this is a long loop of muttiple sutures in the tissue being lifted. The sutures that elevate the soft tissue of the face are then sutured to bony tissue. This gives a very secure fixation of the tissue. 
Technique of the MACS is very important not to have skin uneveness, etc. Consult with a Plastic Surgeon experienced with the MACS Face Lift.

William H. Jervis, MD, FACS (in memoriam) · Answer

very complicated questions. any facelifting technic depends on the surgeons training and experience.  so any technic may work better than another for any given surgeon.  macs usually means shorter incisions at the cost of having less skin excision to hold your face up as well or as long.  all technics have their advantages and drawbacks.  if in doubt get several opinions.

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