Why do doctors suggestion MACS Lift for a secondary procedure?

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. 

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 

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. 

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

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!