What the research shows
The best known short scar lift is the MACS lift, short for minimal access cranial suspension. Through a short incision, the surgeon places strong permanent stitches in loops in the SMAS layer and ties them to firm tissue above the ear, which lifts the jowls and upper neck straight up (Tonnard 2002). A third loop lifts the cheek fat and softens the fold beside the nose (Verpaele 2007). Other short scar lifts trim and stitch the SMAS (Baker 2001) or release it in the deep plane through the same short incision (Jacono 2011).
It is a low-risk operation. Most patients have it awake or under light sedation, and across published series about 1 in 30 had a complication, most often a small blood collection that rarely needed a return to the operating room (Amador 2024). Pooled MACS reports found no major complications (Hijkoop 2022). In a large practice the most common problem was a buried stitch working its way out, in about 1 in 7, a minor problem (Tanna 2008). Patients returned to work in about two weeks, and the operation took less time than a conventional facelift (Mast 2014).
The face results match a full facelift, at least for a while. Two short scar methods gave the same result at two years (Prado 2006). In identical twins assigned to a short or a full incision, results were the same at about one year; at five years the full incision scored better in the neck (Antell 2016).
The neck is the limit. The originators added neck procedures when cords or skin folds below the earlobe remained (Tonnard 2005), and a surgeon who had switched to MACS for most patients cut back after seeing loose necks and skin pleats, keeping it for younger patients with less neck laxity (Buchanan 2018, Mast 2014).
Where surgeons disagree
- How long the result lasts. One comparison found that more than half of short scar patients would benefit from a skin tuck for jowls and loose skin by two years (Prado 2006). Others report high satisfaction and low revision rates (Tanna 2008, Verpaele 2007).
- Short scar or deeper lift. A pooled comparison found MACS and deeper SMAS lifts gave similar appearance and complications, with a shorter MACS operation (Pandkhahi 2026). Surgeons who favor the full incision point to the five-year neck result in twins (Antell 2016).
What is new
- The short scar lift is now rarely done alone. In one practice nearly every MACS patient also had fat grafting, and most had brow, neck or eyelid surgery in the same session, with no major complications (Sommar 2026).
- Adding fat grafting to MACS improved the tear trough and cheek more than the lift alone (Willemsen 2011).
- Drains or tissue glue were linked to fewer complications after limited incision lifts (Amador 2024).
What is still unknown
- Long-term results against a full facelift: the only randomized comparison is a small twin series (Antell 2016).
- How strong the evidence is: half of the studies in the MACS review were of low quality (Hijkoop 2022).
Key papers
- Baker 2001: the short scar lift with lateral SMAS trimming, and which patients suit it.
- Tonnard 2002: first description of the MACS lift.
- Verpaele 2007: the third stitch that lifts the cheek.
- Tanna 2008: complications in a large short scar series; stitch extrusion led the list.
- Jacono 2011: a deep plane lift through a short incision.
- Antell 2016: identical twins; equal faces at one year, better necks with the full incision at five.
- Hijkoop 2022: MACS review; safe, with limited neck effect.
- Amador 2024: pooled complication rate of limited incision lifts.
- Sommar 2026: MACS combined with fat grafting and other procedures.