Short-scar facelift and MACS lift

What it is

A full facelift incision continues behind the ear. A short-scar lift avoids that extension: the MACS incision runs in front of the ear and along the bottom of the sideburn (PMID 11994618), and because the face is lifted straight up, the skin is redraped without an incision behind the ear (PMID 18922317).

Underneath, the deeper layer is still tightened:

• MACS lift (minimal access cranial suspension): two or three strong permanent purse-string sutures are woven through the SMAS and tied to the firm temple fascia above the ear, pulling the neck, jowl and cheek straight up (PMID 11994618, PMID 17604708).
• Short scar with lateral SMASectomy: a strip of SMAS is removed and the edges sewn together, as in a full SMAS lift (PMID 19331867, PMID 18922307).
• Minimal access deep plane: the cheek ligaments are released under the SMAS through the short incision before the vertical lift (PMID 22065880, PMID 23731580).

Where it came from

• Early facelift surgery: Suzanne Noël's "petit operation" set out ideas the short-scar lift still uses: incisions hidden in the hairline, short incisions, no tension on the skin and careful choice of direction (PMID 31637506).
• 2001: Daniel Baker reported a decade of minimal incision facelifts with lateral SMASectomy and complication rates similar to standard lifts (PMID 19331867).
• 2002: Patrick Tonnard and Alexis Verpaele turned the 1999 S-lift into the MACS lift, done under local anesthesia with purse-string sutures (PMID 11994618). In 2007 they added a third suture for the cheek and lower eyelid (PMID 17604708).
• 2011: Andrew Jacono combined the short incision with a deep plane release (PMID 22065880).
• Today the MACS lift is a small and shrinking share of facelifts among board-certified plastic surgeons in the United States (PMID 38302713), and in one recent practice it was combined with fat grafting, neck work or skin treatments in nearly every patient (PMID 40906287).

Who it suits

• People with jowls and sagging cheeks whose main concern is the lower face, with good skin and limited loose skin in the neck (PMID 34922854, PMID 18922317).
• People who want a smaller scar, a shorter operation or local anesthesia (PMID 37950895, PMID 41597398).
• Jacono describes an examination step that tests whether a face can be corrected through the short access (PMID 23731580).
• People with a heavy, aged neck usually need more: the MACS lift's effect on the neck is limited, and extra neck work is added for it (PMID 34922854).

Results and how long they last

• In the short term, short-scar and full lifts look alike. In twins and triplets randomized to a full or short incision by one surgeon, reviewers saw no difference at about a year; at about five years the full incision scored better in the neck (PMID 26890507).
• In a meta-analysis comparing the MACS lift with a deeper SMAS lift, the cosmetic results and complications were similar and the MACS operation was shorter (PMID 41597398).
• Satisfaction was high in every MACS study in a systematic review (PMID 34922854). In one surgeon's comparison, a few MACS patients were disappointed by loose skin left over or by their neck contour (PMID 24691336).
• The third, cheek suture of the extended MACS restored cheek volume, softened the fold beside the mouth and supported the lower eyelid (PMID 17604708).
• A MACS lift can be retightened in a later revision (PMID 20108092).
• Suture suspension without releasing the facial ligaments drags the support fibers upward and puts the weight of the face on the sutures, which anatomists argue limits how long it lasts (PMID 37747400).

Risks and how surgeons lower them

• Complications are infrequent: about 3 in 100 patients in a review of limited incision facelifts (PMID 37950895).
• Hematoma was the most common, at about 2 in 100, and rarely needed a return to the operating room (PMID 37950895). Drains or tissue sealants were linked to far fewer complications (PMID 37950895).
• Temporary nerve weakness and skin loss were rare in that review (PMID 37950895). The MACS systematic review found no major complications (PMID 34922854).
• When many procedures are added to the MACS lift, minor problems such as temporary nerve weakness, infection, small areas of skin loss and saliva or fluid collections each occurred in under 5 in 100 patients (PMID 40906287).
• Vertical skin folds below the earlobe can appear in people with poor skin quality and are corrected with a small extension behind the ear (PMID 18922317).

Recovery

• MACS patients returned to work at about 2 weeks on average (PMID 24691336).
• The MACS operation was about an hour and a half shorter than a conventional facelift in that series (PMID 24691336).
• Most limited incision facelifts are done awake under local anesthesia or with light sedation (PMID 37950895). Less dissection is reported to bring less swelling and a shorter recovery (PMID 37950895).
• The originators describe the recovery as swift, with minimal morbidity (PMID 18922317).

Questions to ask a surgeon

• Ask whether the neck can be corrected through a short incision, or whether a full incision would serve it better over time (PMID 26890507).
• Ask what is done to the SMAS under the short incision: sutures only, SMASectomy or a deep plane release (PMID 37747400).
• Ask whether the lift will be done under local anesthesia and whether drains or sealants are used (PMID 37950895).
• Ask which added procedures are planned and why (PMID 40906287).

Open questions

• The neck: short scar and MACS lifts have a limited neck effect (PMID 34922854), and the twin study favored the full incision in the neck at 5 years (PMID 26890507).
• How long suture suspension without release lasts has not been measured in long-term trials (PMID 37747400).
• Comparative trials of MACS against SMAS lifts are few and small (PMID 41597398).
• The MACS lift is now usually one part of a combined operation, so the effect of the lift alone is hard to isolate (PMID 40906287).

Terms

• Short-scar facelift: a facelift with a shorter incision to limit scar visibility (PMID 37950895).
• MACS lift: minimal access cranial suspension; purse-string SMAS sutures anchored to the deep temple fascia (PMID 11994618).
• Purse-string suture: a suture woven in a loop and tied to gather tissue (PMID 17604708).
• Extended MACS: the MACS lift with a third suture for the cheek (PMID 17604708).
• S-lift: the 1999 forerunner of the MACS lift (PMID 11994618).
• Lateral SMASectomy: removing a strip of SMAS and closing the gap (PMID 18922307).
• Limited incision facelift: the umbrella term for short-incision approaches (PMID 37950895).

Papers