Is There a Serious Risk of Cheek Bumpiness After a MACS Facelift?

I am seriously considering having a MACS facelift. I had a full facelift 7 years ago and one cheek remained bruised for a long time, so I know that I have thin skin as well as a thin face. I have researched a lot and am aware that there can be bumpiness in the cheeks caused by the deep sutres, and I am very concderned that with a thin face I might have long lasting bumpiness. Is this a realistic concern and would there be any treatment should this occur.

Doctor Answers 12

MACS Lift for Revision Facelift

I do not recommend the MACS lift in thin face patients.   As you have pointed out, the pursestring suturing is prone to bunching, causing an unnatural bumpy appearance in the thin face.    As a revision facelift, I would encourage you to undergo a SMAS plication with wide undermining.    Revision patients typically do not swell and bruise to the same extent as the primary procedure.

I recommend that you consult with 3 board certified plastic surgeons to help you make the most educated decision.


I wish you a safe recovery and amazing result!!


Dr. Gill

Houston Plastic Surgeon
5.0 out of 5 stars 75 reviews


There are many nuances of each type of facelift. I think the MAC procedure is an excellent one for a secondary facelift. In my hands the Lite Lift is a modified MAC facelift where I use in addition to the purse-string suture an absorbable suture to make sure that the surface is completely smooth. This has prevented visible bumps and lumps that can be visible in those with "thin skin".

The best advice I can give you is to choose your surgeon wisely. Great surgeons usually get great results !

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 107 reviews

MACS facelift and Thin Skin

   MACS facelift involves pursestring sutures, which elevate the deeper tissues.  The sutures can create lumps and bumps and are more noticeable in patients with thin skin.  Other techniques may be more appropriate.  Find the plastic surgeon with ELITE credentials who performs hundreds of facelifts each year.  Kenneth Hughes, MD Los Angeles, CA

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MACS Facelift Revision

I am not a tremendous fan of the MACS Facelift in most circumstances, but would definitely recommend against it in the setting of a thin face.  In my experience, the "purse string" of the MACS lift lack durability in aesthetic effect.  It's a procedure that is designed more for Surgical speed and more moderate aging indications than a typical SMAS procedure.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
5.0 out of 5 stars 74 reviews

Properly performed limited facelift...

The concept of a MACS facelift is to perform “minimal elevation of the skin” and to work with a “short scar”. Procedures like the MACS facelift are indicated in some patients with minimal descent and who require a lifting without much effect on the neck area. Given that you have a thin face and there is a concern with bumps I think it is probably better for you to consider a limited “proper” facelift where you are not depending on suspension sutures which literally bunch up the tissue under the skin and lift it up. I think you can achieve (with the right hands) a properly performed limited facelift which can provide you with a quick recovery experience that most people are looking for who are considering a MACS facelift.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.5 out of 5 stars 58 reviews

Is There a Serious Risk of Cheek Bumpiness After a MACS Facelift?

 Whenever the SMAS layer is folded on itself or plicated with suspension sutures or threads, there is the risk of lumpiness in the face.  I prefer to use SMAS imbrication techniques that dissesct, lift and trim the SMAS.  This does not leave lumps and is part of our Celebrity Face Lift.  Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 17 reviews

Bumpiness after MACS lift

The Technique of MACS lift involves gathering up the SMAS layer with sutures in order to tighten it. This technique by necessity creates some lumpiness in the deep layer that can be seen through the skin. Patient with thick skin well see this less than those with thin skin. The Sutures can be dissolvable if the surgeon prefers so this usually resolves. Other techniques can cause less of this lumpiness so if you have thin skin discuss your concerns with your surgeon.

Thomas Buonassisi, MD
Vancouver Facial Plastic Surgeon
5.0 out of 5 stars 89 reviews

MACS lift uneveness

The MACS lift has become en vogue the last few years.  It is a simpler facelift and requires less anatomic knowledge than a deeper plane lift.  The main issue with a MACS lift is that the skin is separated from the SMAS layer and then a suture attempts to purse string the SMAS and lift it with a permanent suture.  This has been changed to a longer lasting suture by some surgeons.  The issue is that the deeper tissue is not been lifted but rather gathered so it is very common to see uneveness early after this lift and not uncommon to see asymmetries afterwards.  

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 118 reviews

Bumpiness after MACS face lift

MACS face lift sutures are likely to cause bumpiness in thin skin because -

  1. the tissue gathered by the sutures forms ruffles. To avoid this the surgeon takes small bites of tissue, not large ones.
  2. You can feel the sutures under your skin. To minimize this, PDS or similar absorbable sutures are usually used. Bumpiness temporarily increases when they start to absorb - 6 weeks after surgery - and subsides in another few weeks. 

Discuss with your plastic surgeon simply re-doing the earlier face lift, instead of doing a MACS. The advantage of the MACS is that the incision is short - but you already have the incision from your previous surgery. The second advantage is that surgery is shortened - but redo face lifts take less time than the first one.

Don't fret - it's nice to have two good options!

Nonabsorbable sutures causing bumpiness

The bumpiness you refer to is likely due to non-absorbable or permanent sutures used for the facelift and is easily avoided by using absorbable or dissolveable sutures. The original MACs lift was described using permanent sutures but now the technique is suggested with an absorbable suture, so that should be one less think to worry about... even if it did occur, it is usually caused by the knot on the suture and that can always be cut out after a few months without affecting the results of the procedure. 

Dilip D. Madnani, MD, FACS
New York Facial Plastic Surgeon
5.0 out of 5 stars 59 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.